Healthcare Provider Details

I. General information

NPI: 1578628202
Provider Name (Legal Business Name): MARLYS SANDVE MCDEVITT CRNP-FAMILY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARLYS SANDVE FNP

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 FOREST DR
ANNAPOLIS MD
21403-1482
US

IV. Provider business mailing address

PO BOX 12622
BELFAST ME
04915-4017
US

V. Phone/Fax

Practice location:
  • Phone: 443-699-0165
  • Fax:
Mailing address:
  • Phone: 443-481-6577
  • Fax: 443-481-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR214293
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP2794
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: