Provider Demographics
NPI:1275370678
Name:DEVANY, CAROLINE S (NP)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:S
Last Name:DEVANY
Suffix:
Gender:U
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 13TH ST OFC PO12065
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3941
Mailing Address - Country:US
Mailing Address - Phone:925-451-2819
Mailing Address - Fax:
Practice Address - Street 1:201 13TH ST OFC PO12065
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3941
Practice Address - Country:US
Practice Address - Phone:925-451-2819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030893363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care