MEDICARE: DEVON GILBERT

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
1	163W00000X	Registered Nurse	4704248232	MI
2	363LA2100X	Acute Care Nurse Practitioner	4704248232	MI

General Provider Information

NPI Number	:	1184170078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVON GILBERT

Provider Business Mailing Address
First Line	:	28252 MILL RIVER BLVD
Second Line	:
City	:	NEW HUDSON
State	:	MI
Zip	:	48165-8125
Country	:	US
Telephone Number	:	248-464-4572
Fax Number	:

Provider Business Practice Location Address
First Line	:	28252 MILL RIVER BLVD
Second Line	:
City	:	NEW HUDSON
State	:	MI
Zip	:	48165-8125
Country	:	US
Telephone Number	:	248-464-4572
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2016
Last Update Date	:	01/20/2017

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