Provider Demographics
NPI:1366054777
Name:RAGAN, DEVON
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:RAGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:CONOWINGO
Mailing Address - State:MD
Mailing Address - Zip Code:21918-1325
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:432 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:CONOWINGO
Practice Address - State:MD
Practice Address - Zip Code:21918-1325
Practice Address - Country:US
Practice Address - Phone:443-747-1071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN