Provider Demographics
NPI:1306628755
Name:VARNER, DEVON NOELLE (RN)
Entity type:Individual
Prefix:MRS
First Name:DEVON
Middle Name:NOELLE
Last Name:VARNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:DEVON
Other - Middle Name:NOELLE
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:51781 HUNTINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LA PINE
Mailing Address - State:OR
Mailing Address - Zip Code:97739-1118
Mailing Address - Country:US
Mailing Address - Phone:541-907-7050
Mailing Address - Fax:
Practice Address - Street 1:51781 HUNTINGTON RD
Practice Address - Street 2:
Practice Address - City:LA PINE
Practice Address - State:OR
Practice Address - Zip Code:97739-1118
Practice Address - Country:US
Practice Address - Phone:541-907-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORXXXXXX363LF0000X
CA95178810390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty