Healthcare Provider Details

I. General information

NPI: 1730956442
Provider Name (Legal Business Name): DEVANNE MARIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 HARDING PIKE
NASHVILLE TN
37205-2005
US

IV. Provider business mailing address

1142 GENEIL LN
LA VERGNE TN
37086-2572
US

V. Phone/Fax

Practice location:
  • Phone: 620-253-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number177090
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: