Provider Demographics
NPI:1699233775
Name:DEVINS, KARISSA (KARISSA)
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:DEVINS
Suffix:
Gender:F
Credentials:KARISSA
Other - Prefix:
Other - First Name:KARISSA
Other - Middle Name:
Other - Last Name:HOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:654 STETSON RD
Mailing Address - Street 2:
Mailing Address - City:CHAZY
Mailing Address - State:NY
Mailing Address - Zip Code:12921-2256
Mailing Address - Country:US
Mailing Address - Phone:518-593-1274
Mailing Address - Fax:
Practice Address - Street 1:654 STETSON RD
Practice Address - Street 2:
Practice Address - City:CHAZY
Practice Address - State:NY
Practice Address - Zip Code:12921-2256
Practice Address - Country:US
Practice Address - Phone:518-593-1274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist