Basic Information
| Provider Information | |||||||||
| NPI: | 1942925094 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DEVLIEGER | ||||||||
| FirstName: | FAITH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 N SUMMIT ST FL 15 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436041531 | ||||||||
| CountryCode: | US | ||||||||
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| FaxNumber: | 8005645952 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 THOMAS JONES WAY | ||||||||
| Address2: | |||||||||
| City: | EXTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193412531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004271902 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2022 | ||||||||
| LastUpdateDate: | 10/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | 2022041781 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.