Healthcare Provider Details

I. General information

NPI: 1265240592
Provider Name (Legal Business Name): DEVYN BRITTANY NICKERSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12351 PERRY HWY
WEXFORD PA
15090-8344
US

IV. Provider business mailing address

154 WALNUT DR
BADEN PA
15005-2356
US

V. Phone/Fax

Practice location:
  • Phone: 724-939-3673
  • Fax:
Mailing address:
  • Phone: 304-312-5793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN709595
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number153128
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: