Provider Demographics
NPI:1962462374
Name:DEVILLENEUVE, JENNIFER W (CRNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:W
Last Name:DEVILLENEUVE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 CARRAWAY BLVD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35234-1913
Mailing Address - Country:US
Mailing Address - Phone:205-297-9801
Mailing Address - Fax:205-297-9804
Practice Address - Street 1:4409 BRIAR GLEN DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35243-1723
Practice Address - Country:US
Practice Address - Phone:205-796-8860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7453518207Q00000X
AL1-097679363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-28143OtherBLUE CROSS
ALQ47892Medicare UPIN