=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154882165
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN KATHRYN DEVANNEY FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2019
-----------------------------------------------------
Last Update Date | 10/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4711 S CROATAN HWY STE 6B
-----------------------------------------------------
City | NAGS HEAD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27959-8997
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-441-0515
-----------------------------------------------------
Fax | 252-441-0531
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 801 YORK ST
-----------------------------------------------------
City | MANITOWOC
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54220-4630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-663-9008
-----------------------------------------------------
Fax | 920-684-1439
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 5016076
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------