Provider Demographics
NPI:1134773666
Name:DEBOW, NIKELA SHANEY (CMN, P)
Entity type:Individual
Prefix:
First Name:NIKELA
Middle Name:SHANEY
Last Name:DEBOW
Suffix:
Gender:F
Credentials:CMN, P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13794 W WADDELL RD # 203-163
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-8499
Mailing Address - Country:US
Mailing Address - Phone:702-782-0967
Mailing Address - Fax:
Practice Address - Street 1:9920 W CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-5060
Practice Address - Country:US
Practice Address - Phone:702-782-0967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy