Provider Demographics
NPI:1033968722
Name:DEVIRGILIIS, WENDY (APN)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:DEVIRGILIIS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:ACEVEDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN
Mailing Address - Street 1:31 KARYN TER W
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-1207
Mailing Address - Country:US
Mailing Address - Phone:732-832-5540
Mailing Address - Fax:
Practice Address - Street 1:31 KARYN TER W
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-1207
Practice Address - Country:US
Practice Address - Phone:732-832-5540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15074600363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner