MEDICARE: PATRICIA MARIA DEVRIES NP

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	363LA2200X	Adult Health Nurse Practitioner	4704168822	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0N33890	OTHER	MI	MEDICARE GROUP PIN

General Provider Information

NPI Number	:	1467457143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA MARIA DEVRIES NP

Provider Business Mailing Address
First Line	:	PO BOX 1848
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49443-1848
Country	:	US
Telephone Number	:	616-296-1600
Fax Number	:	616-296-1602

Provider Business Practice Location Address
First Line	:	1310 WISCONSIN ST STE 100
Second Line	:
City	:	GRAND HAVEN
State	:	MI
Zip	:	49417-2472
Country	:	US
Telephone Number	:	616-296-1600
Fax Number	:	616-296-1604

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	01/05/2022

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