Provider Demographics
NPI:1588274997
Name:DEVINE, RACHEL LYNN (FNP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNN
Last Name:DEVINE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3137 WEBB RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903-5527
Mailing Address - Country:US
Mailing Address - Phone:607-206-2200
Mailing Address - Fax:
Practice Address - Street 1:3101 SHIPPERS RD STE 202
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2082
Practice Address - Country:US
Practice Address - Phone:607-754-5342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-01
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346275363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily