Provider Demographics
NPI:1083419220
Name:DEVINE, DONALD
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:DEVINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4145 TOWNSHIP ROAD 180
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-9413
Mailing Address - Country:US
Mailing Address - Phone:937-441-6856
Mailing Address - Fax:
Practice Address - Street 1:4145 TOWNSHIP ROAD 180
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-9413
Practice Address - Country:US
Practice Address - Phone:937-441-6856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide