Basic Information
| Provider Information | |||||||||
| NPI: | 1154882165 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEVANNEY | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | KATHRYN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 YORK ST | ||||||||
| Address2: | |||||||||
| City: | MANITOWOC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 542204630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9206639008 | ||||||||
| FaxNumber: | 9206841439 | ||||||||
| Practice Location | |||||||||
| Address1: | 4711 S CROATAN HWY STE 6B | ||||||||
| Address2: | |||||||||
| City: | NAGS HEAD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 279598997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524410515 | ||||||||
| FaxNumber: | 2524410531 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2019 | ||||||||
| LastUpdateDate: | 08/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 5016076 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.