Basic Information
| Provider Information | |||||||||
| NPI: | 1518189083 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEVENNEY | ||||||||
| FirstName: | PHILIPPA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 E. 1ST STREET | ||||||||
| Address2: | KATHERINE SHAW BETHEA HOSPITAL | ||||||||
| City: | DIXON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 61021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8152855629 | ||||||||
| FaxNumber: | 8152855634 | ||||||||
| Practice Location | |||||||||
| Address1: | 403 E. 1ST STREET | ||||||||
| Address2: | KATHERINE SHAW BETHEA HOSPITAL | ||||||||
| City: | DIXON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 61021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8152855629 | ||||||||
| FaxNumber: | 8152855634 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 06/27/2016 | ||||||||
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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 | 207R00000X | 036098532 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 036-098532 | IL | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.