Provider Demographics
NPI:1194314625
Name:JEWELL, DEVIN
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:
Last Name:JEWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DEVIN
Other - Middle Name:
Other - Last Name:JEWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:STNA
Mailing Address - Street 1:6281 MARSH WREN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6533
Mailing Address - Country:US
Mailing Address - Phone:419-513-9963
Mailing Address - Fax:
Practice Address - Street 1:6281 MARSH WREN DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-6533
Practice Address - Country:US
Practice Address - Phone:419-513-9963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400923920609376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide