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NPI Code Detail

MEDICARE: NICHOLAS DEVETTER DO

MEDICARE: NICHOLAS DEVETTER DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician74880MN

General Provider Information

NPI Number : 1114677671
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS DEVETTER DO
Provider Business Mailing Address
First Line : PO BOX 8674
Second Line :
City : MANKATO
State : MN
Zip : 56002-8674
Country : US
Telephone Number : 507-625-1811
Fax Number : 507-625-4754
Provider Business Practice Location Address
First Line : 1901 OLD MINNESOTA AVE
Second Line :
City : SAINT PETER
State : MN
Zip : 56082-1763
Country : US
Telephone Number : 507-625-1811
Fax Number : 507-625-4754
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2022
Last Update Date : 01/20/2026

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