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General NPI Number Information
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NPI Number | 1043055338
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Entity Type | Organization
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Legal Business Name | DEVA WELLNESS PLLC
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Dates
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Enumeration Date | 06/27/2024
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Last Update Date | 06/27/2024
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Provider Practice Location Address
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Address Line | 1620 W BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83702-5156
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Country | US
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Telephone | 208-918-2242
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Fax |
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Provider Business Mailing Address
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Address Line | 4280 N GINZEL ST
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City | BOISE
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State | ID
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Zip | 83703-4214
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Country | US
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Telephone | 413-687-3027
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Fax |
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Authorized Official
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Title or Position | OWNER, FNP-X
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Name | TAMRA KATHERINE GERYK
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Credential | APRN, FNP-C
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Telephone | 413-687-3027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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