Provider Demographics
NPI:1972805893
Name:RAMBERT-HAIRSTON, DEVON MARSHALLE (DNP, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:DEVON
Middle Name:MARSHALLE
Last Name:RAMBERT-HAIRSTON
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:DR
Other - First Name:DEVON
Other - Middle Name:MARSHALLE
Other - Last Name:RAMBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, FNP-BC
Mailing Address - Street 1:2711 RANDOLPH RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-2034
Mailing Address - Country:US
Mailing Address - Phone:704-910-5982
Mailing Address - Fax:
Practice Address - Street 1:2711 RANDOLPH RD
Practice Address - Street 2:SUITE 207
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2034
Practice Address - Country:US
Practice Address - Phone:704-910-5982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4416363L00000X
NC5004878363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7005652Medicaid
SCNP1767Medicaid
NC7005652Medicaid
NCNC3097BMedicare PIN