MEDICARE: CYNTHIA DEVINE 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	363LG0600X	Gerontology Nurse Practitioner	AP7610	AZ

General Provider Information

NPI Number	:	1730579426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA DEVINE NP

Provider Business Mailing Address
First Line	:	1100 S DOBSON RD STE 105
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85286-6158
Country	:	US
Telephone Number	:	480-289-4550
Fax Number	:	480-289-4551

Provider Business Practice Location Address
First Line	:	1100 S DOBSON RD STE 105
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85286-6158
Country	:	US
Telephone Number	:	480-289-4550
Fax Number	:	480-289-4551

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

Provider Enumeration Date	:	02/02/2015
Last Update Date	:	12/09/2020

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