Provider Demographics
NPI:1750952099
Name:ACKER, DEBORAH JEAN (JD, MSN, CNM, RN)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JEAN
Last Name:ACKER
Suffix:
Gender:F
Credentials:JD, MSN, CNM, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 BUNKHOUSE CT
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-8900
Mailing Address - Country:US
Mailing Address - Phone:650-575-5452
Mailing Address - Fax:
Practice Address - Street 1:2710 GATEWAY OAKS DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95833-3505
Practice Address - Country:US
Practice Address - Phone:650-575-5452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN295625163WP1700X
CA257367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WP1700XNursing Service ProvidersRegistered NursePerinatal