Healthcare Provider Details

I. General information

NPI: 1275370678
Provider Name (Legal Business Name): CAROLINE S DEVANY NP
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 13TH ST OFC PO12065
OAKLAND CA
94612-3941
US

IV. Provider business mailing address

201 13TH ST OFC PO12065
OAKLAND CA
94612-3941
US

V. Phone/Fax

Practice location:
  • Phone: 925-451-2819
  • Fax:
Mailing address:
  • Phone: 925-451-2819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95030893
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: