MEDICARE: ROSE B DEVALLON NP

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024197679	VA

General Provider Information

NPI Number	:	1740081488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSE B DEVALLON NP

Provider Business Mailing Address
First Line	:	219 GRUEN ST
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23323-5601
Country	:	US
Telephone Number	:	224-545-1690
Fax Number	:

Provider Business Practice Location Address
First Line	:	307 TRENT DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27710-3038
Country	:	US
Telephone Number	:	224-545-1690
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2025
Last Update Date	:	06/09/2026

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