Provider Demographics
NPI:1194788059
Name:DEVLIN, MARIE ELIZABETH (CRNA)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:ELIZABETH
Last Name:DEVLIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CARLISLE DR
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-9117
Mailing Address - Country:US
Mailing Address - Phone:724-744-3531
Mailing Address - Fax:
Practice Address - Street 1:400 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:BRADDOCK
Practice Address - State:PA
Practice Address - Zip Code:15104-1599
Practice Address - Country:US
Practice Address - Phone:412-636-5612
Practice Address - Fax:412-636-5689
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN-204868-L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN204868LOtherRN LICENSE
030970OtherNATIONAL CRNA
S60598Medicare UPIN
PA013628Medicare ID - Type Unspecified