Provider Demographics
NPI:1558107052
Name:DEVORE, ANGELA GRACE (DNP, FNP-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:GRACE
Last Name:DEVORE
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N CLIPPERT ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-4701
Mailing Address - Country:US
Mailing Address - Phone:517-999-2273
Mailing Address - Fax:
Practice Address - Street 1:505 N CLIPPERT ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4701
Practice Address - Country:US
Practice Address - Phone:517-999-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704245059207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine