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NPI Code Detail

MEDICARE: ELIZABETH DEVINE MSN FNP

MEDICARE: ELIZABETH DEVINE MSN FNP
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
1363LF0000XFamily Nurse PractitionerNP19048CA

General Provider Information

NPI Number : 1689735979
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH DEVINE MSN FNP
Provider Business Mailing Address
First Line : 14007 PALAWAN WAY APT 205
Second Line :
City : MARINA DEL REY
State : CA
Zip : 90292-6269
Country : US
Telephone Number : 310-578-1381
Fax Number :
Provider Business Practice Location Address
First Line : 4425 S CENTRAL AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90011-3629
Country : US
Telephone Number : 323-908-4200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2006
Last Update Date : 06/19/2012

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Directions to “ ELIZABETH DEVINE MSN FNP” Practice Location

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