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NPI Code Detail

MEDICARE: MRS. THERESA EILEEN DEVEAUX CRNP

MEDICARE: MRS. THERESA EILEEN DEVEAUX CRNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2100XAcute Care Nurse PractitionerR093166MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1F591 0008OTHERDCCAREFIRST BLUE CROSS DC
24992OTHERMDBRAVO/ELDER HEALTH
361740701OTHERMDCAREFIRST BLUE CROSS MD
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5107423OTHERMDAMERIGROUP
622500900OTHERMDCIGNA

General Provider Information

NPI Number : 1013919067
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. THERESA EILEEN DEVEAUX CRNP
Provider Business Mailing Address
First Line : 301 HOSPITAL DRIVE
Second Line :
City : GLEN BURNIE
State : MD
Zip : 21061
Country : US
Telephone Number : 410-553-8300
Fax Number : 410-553-8349
Provider Business Practice Location Address
First Line : 301 HOSPITAL DR
Second Line :
City : GLEN BURNIE
State : MD
Zip : 21061-5803
Country : US
Telephone Number : 410-553-8300
Fax Number : 410-553-8349
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2005
Last Update Date : 07/20/2016

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