Basic Information
| Provider Information | |||||||||
| NPI: | 1013919067 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEVEAUX | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | EILEEN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 HOSPITAL DRIVE | ||||||||
| Address2: | |||||||||
| City: | GLEN BURNIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105538300 | ||||||||
| FaxNumber: | 4105538349 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | GLEN BURNIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210615803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105538300 | ||||||||
| FaxNumber: | 4105538349 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2005 | ||||||||
| LastUpdateDate: | 07/20/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | R093166 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | F591 0008 | 01 | DC | CAREFIRST BLUE CROSS DC | OTHER | 4992 | 01 | MD | BRAVO/ELDER HEALTH | OTHER | 61740701 | 01 | MD | CAREFIRST BLUE CROSS MD | OTHER | 400067600 | 05 | MD | MEDICAID | 107423 | 01 | MD | AMERIGROUP | OTHER | 22500900 | 01 | MD | CIGNA | OTHER |