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General NPI Number Information
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NPI Number | 1962462374
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Entity Type | Individual
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Provider Name | JENNIFER W DEVILLENEUVE CRNP
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Gender | Female
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Dates
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Enumeration Date | 03/28/2006
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 4409 BRIAR GLEN DR
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City | MOUNTAIN BRK
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State | AL
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Zip | 35243-1723
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Country | US
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Telephone | 205-796-8860
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 CARRAWAY BLVD SUITE 402
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City | BIRMINGHAM
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State | AL
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Zip | 35234-1913
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Country | US
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Telephone | 205-297-9801
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Fax | 205-297-9804
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 7453518
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1-097679
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License Number State | AL
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