Basic Information
| Provider Information | |||||||||
| NPI: | 1629603998 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEVENS | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | MAGEE | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 315 BONNIE BRAE AVE | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146182131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3158719069 | ||||||||
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| Practice Location | |||||||||
| Address1: | 480 GENESEE ST | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146113634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5854363040 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2020 | ||||||||
| LastUpdateDate: | 08/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 542003-1 | NY | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 346111 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.