Individual
EVAN BLAKE DEBOARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4355 HICKORY BLVD STE 2, GRANITE FALLS, NC 28630-2014
(828) 757-5050
Mailing address
329 GLEN ECHO LN APT D, CARY, NC 27518-9634
(423) 416-0256
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
DEBO-F0JH8
NC
Other
Enumeration date
11/24/2021
Last updated
03/23/2022
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