Provider Demographics
NPI:1730579426
Name:DEVINE, CYNTHIA (NP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:DEVINE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S DOBSON RD STE 105
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-6158
Mailing Address - Country:US
Mailing Address - Phone:480-289-4550
Mailing Address - Fax:480-289-4551
Practice Address - Street 1:1100 S DOBSON RD STE 105
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-6158
Practice Address - Country:US
Practice Address - Phone:480-289-4550
Practice Address - Fax:480-289-4551
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAP7610363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology