Provider Demographics
NPI:1174962625
Name:DEVINE, JANNETTE MARIE (RN)
Entity type:Individual
Prefix:MISS
First Name:JANNETTE
Middle Name:MARIE
Last Name:DEVINE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9106 DUTCHTOWN ROAD EXTENSION
Mailing Address - Street 2:
Mailing Address - City:MINERAL CITY
Mailing Address - State:OH
Mailing Address - Zip Code:44656-9106
Mailing Address - Country:US
Mailing Address - Phone:330-859-2864
Mailing Address - Fax:
Practice Address - Street 1:9106 DUTCHTOWN ROAD EXTENSION
Practice Address - Street 2:
Practice Address - City:MINERAL CITY
Practice Address - State:OH
Practice Address - Zip Code:44656-9106
Practice Address - Country:US
Practice Address - Phone:330-859-2864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH387871163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse