Provider Demographics
NPI:1497815609
Name:DEVLIN, LIAM CHRISTOPHER (FNP)
Entity type:Individual
Prefix:
First Name:LIAM
Middle Name:CHRISTOPHER
Last Name:DEVLIN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-6902
Mailing Address - Country:US
Mailing Address - Phone:907-277-1440
Mailing Address - Fax:907-277-1446
Practice Address - Street 1:172 MAIN ST.
Practice Address - Street 2:
Practice Address - City:SAND POINT
Practice Address - State:AK
Practice Address - Zip Code:99661
Practice Address - Country:US
Practice Address - Phone:907-383-3151
Practice Address - Fax:907-383-6074
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK144363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCL 9107Medicaid
AKCL 1391Medicaid
AKCL 6515Medicaid
AKCL 9171Medicaid
AKCL 6515Medicaid