Provider Demographics
NPI:1356878540
Name:DEBOER, NIKKI L (CRNP)
Entity type:Individual
Prefix:MRS
First Name:NIKKI
Middle Name:L
Last Name:DEBOER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 E MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:PA
Mailing Address - Zip Code:17268-2318
Mailing Address - Country:US
Mailing Address - Phone:717-762-9118
Mailing Address - Fax:717-762-2860
Practice Address - Street 1:1051 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:PA
Practice Address - Zip Code:17268-2318
Practice Address - Country:US
Practice Address - Phone:717-762-9118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR218514363LF0000X
MDF05170310363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily