Provider Demographics
NPI:1134228166
Name:WING, DEBRA J (APRN)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:J
Last Name:WING
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:557 W 2600 S
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-7717
Mailing Address - Country:US
Mailing Address - Phone:801-298-9155
Mailing Address - Fax:801-298-9156
Practice Address - Street 1:557 W 2600 S
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-7717
Practice Address - Country:US
Practice Address - Phone:801-298-9155
Practice Address - Fax:801-298-9156
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4930416-4405163WP0000X, 363LF0000X, 363LA2100X
MN184272-0363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily