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NPI Code Detail

MEDICARE: MARLYS SANDVE MCDEVITT CRNP-FAMILY

MEDICARE: MARLYS SANDVE MCDEVITT CRNP-FAMILY
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
1363LF0000XFamily Nurse PractitionerR214293MD
2363LF0000XFamily Nurse PractitionerCNP2794MN

General Provider Information

NPI Number : 1578628202
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARLYS SANDVE MCDEVITT CRNP-FAMILY
Provider Business Mailing Address
First Line : PO BOX 12622
Second Line :
City : BELFAST
State : ME
Zip : 04915-4017
Country : US
Telephone Number : 443-481-6577
Fax Number : 443-481-6515
Provider Business Practice Location Address
First Line : 1419 FOREST DR
Second Line :
City : ANNAPOLIS
State : MD
Zip : 21403-1482
Country : US
Telephone Number : 443-699-0165
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2006
Last Update Date : 12/29/2015

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