Provider Demographics
NPI:1902953904
Name:DEBOER, COLLEEN ANN (ANP)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:ANN
Last Name:DEBOER
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Gender:F
Credentials:ANP
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Mailing Address - Street 1:1 GUSTAVE L LEVY PL
Mailing Address - Street 2:MOUNT SINAI MEDICAL CENTER, BOX 1128
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6500
Mailing Address - Country:US
Mailing Address - Phone:212-659-5649
Mailing Address - Fax:212-659-5599
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:MOUNT SINAI MEDICAL CENTER, BOX 1128
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6500
Practice Address - Country:US
Practice Address - Phone:212-659-5649
Practice Address - Fax:212-659-5599
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2011-05-19
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Provider Licenses
StateLicense IDTaxonomies
NYF302302-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health