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NPI Code Detail

MEDICARE: DEVRY GARITY CPNP

MEDICARE: DEVRY GARITY CPNP
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
1363LP0200XPediatric Nurse Practitioner651AK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1649206186
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEVRY GARITY CPNP
Provider Business Mailing Address
First Line : 961 S LARKSPUR CIR
Second Line :
City : HOMER
State : AK
Zip : 99603-8219
Country : US
Telephone Number : 406-529-3728
Fax Number :
Provider Business Practice Location Address
First Line : 4136 BARTLETT ST
Second Line :
City : HOMER
State : AK
Zip : 99603-7001
Country : US
Telephone Number : 907-235-8586
Fax Number : 907-235-6639
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2006
Last Update Date : 05/27/2014

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