Healthcare Provider Details

I. General information

NPI: 1023539954
Provider Name (Legal Business Name): MINA DEVINE APRN.CNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 VICTORY PKWY
CINCINNATI OH
45206-1754
US

IV. Provider business mailing address

9910 PINEVILLE RD UNIT 101
RALEIGH NC
27617-6314
US

V. Phone/Fax

Practice location:
  • Phone: 513-221-4273
  • Fax:
Mailing address:
  • Phone: 410-409-1417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP.023766
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.342146
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: