Healthcare Provider Details

I. General information

NPI: 1194788059
Provider Name (Legal Business Name): MARIE ELIZABETH DEVLIN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HOLLAND AVE
BRADDOCK PA
15104-1599
US

IV. Provider business mailing address

8 CARLISLE DR
IRWIN PA
15642-9117
US

V. Phone/Fax

Practice location:
  • Phone: 412-636-5612
  • Fax: 412-636-5689
Mailing address:
  • Phone: 724-744-3531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN-204868-L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierRN204868L
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerRN LICENSE
# 2
Identifier030970
Identifier TypeOTHER
Identifier State
Identifier IssuerNATIONAL CRNA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: