Basic Information
| Provider Information | |||||||||
| NPI: | 1205813656 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEBOER | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 98819 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891938819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028678644 | ||||||||
| FaxNumber: | 6027955698 | ||||||||
| Practice Location | |||||||||
| Address1: | 3805 E BELL RD STE 3100 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850322136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028678644 | ||||||||
| FaxNumber: | 6027955698 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 6702 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | PENDING | 01 | AZ | MEDICARE | OTHER | PENDING | 05 | AZ | MEDICAID |