Provider Demographics
NPI:1700158219
Name:MCDEVITT, DIANE (PNP, BC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:MCDEVITT
Suffix:
Gender:F
Credentials:PNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 ORIENTAL AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-7807
Mailing Address - Country:US
Mailing Address - Phone:609-226-3515
Mailing Address - Fax:
Practice Address - Street 1:203 ORIENTAL AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-7807
Practice Address - Country:US
Practice Address - Phone:609-226-3515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00050900363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics