Provider Demographics
NPI:1407178957
Name:DEVERS, SUE LILLIAN (RN)
Entity type:Individual
Prefix:MRS
First Name:SUE
Middle Name:LILLIAN
Last Name:DEVERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:LILLIAN
Other - Last Name:SLEMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3449 E REZANOF DR
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615
Mailing Address - Country:US
Mailing Address - Phone:907-486-9870
Mailing Address - Fax:907-486-9897
Practice Address - Street 1:3449 E REZANOF DR
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615
Practice Address - Country:US
Practice Address - Phone:907-486-9870
Practice Address - Fax:907-486-9897
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4497163W00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCL3225Medicaid
AKCL3225Medicaid