Healthcare Provider Details

I. General information

NPI: 1962826255
Provider Name (Legal Business Name): MARY JANE MCDEVITT RN,MSN,CRNP,CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 W SPROUL RD SUITE 102
SPRINGFIELD PA
19064-2027
US

IV. Provider business mailing address

190 W SPROUL RD SUITE 102
SPRINGFIELD PA
19064-2027
US

V. Phone/Fax

Practice location:
  • Phone: 610-338-1820
  • Fax: 610-338-1825
Mailing address:
  • Phone: 610-338-1820
  • Fax: 610-338-1825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN207834L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP013663
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: