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NPI Code Detail

MEDICARE: ANNJERALD DEVANCE NP

MEDICARE: ANNJERALD DEVANCE 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
1363LF0000XFamily Nurse PractitionerGAA-NP000665GA
2363LF0000XFamily Nurse Practitioner1055067AL

General Provider Information

NPI Number : 1629437785
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNJERALD DEVANCE NP
Provider Business Mailing Address
First Line : PO BOX 746063
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6063
Country : US
Telephone Number : 312-733-9730
Fax Number :
Provider Business Practice Location Address
First Line : 1687 CENTER POINT PKWY STE 121
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35215-5525
Country : US
Telephone Number : 205-557-7022
Fax Number : 205-831-2849
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2016
Last Update Date : 12/19/2024

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