Provider Demographics
NPI:1649670654
Name:BOAN, DEBORAH L (NP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:BOAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 GRANDVILLE ARCH
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23430-6150
Mailing Address - Country:US
Mailing Address - Phone:757-338-6524
Mailing Address - Fax:
Practice Address - Street 1:11828 CANON BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2554
Practice Address - Country:US
Practice Address - Phone:757-599-4922
Practice Address - Fax:757-599-4927
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171931363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily