Provider Demographics
NPI:1104663830
Name:DEVEAU, MARK JASON (BSN, RN)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JASON
Last Name:DEVEAU
Suffix:
Gender:M
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ELISE AVE
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-5018
Mailing Address - Country:US
Mailing Address - Phone:978-888-8256
Mailing Address - Fax:
Practice Address - Street 1:11 ELISE AVE
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-5018
Practice Address - Country:US
Practice Address - Phone:978-888-8256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN10012096163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health