Provider Demographics
NPI:1205813656
Name:DEBOER, ERIN E (PA)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:E
Last Name:DEBOER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:175 INVERNESS DR W STE 300
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5069
Practice Address - Country:US
Practice Address - Phone:720-516-9092
Practice Address - Fax:720-516-9093
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0007776363A00000X
AZ6702363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPENDINGOtherMEDICARE
AZPENDINGMedicaid
WIP92854Medicare UPIN
WIK400150040Medicare PIN
WI0064Medicare ID - Type Unspecified
WI1205813656Medicaid