Healthcare Provider Details

I. General information

NPI: 1992099295
Provider Name (Legal Business Name): FRANCISCA DEVORA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2011
Last Update Date: 06/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 BALLINGER ST
GARDEN CITY KS
67846-5918
US

IV. Provider business mailing address

714 BALLINGER ST
GARDEN CITY KS
67846-5918
US

V. Phone/Fax

Practice location:
  • Phone: 620-275-0291
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number13-102753-081
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number13-102753-081
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: