Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | OP60792644 | WA |
NPI | 1023461316 |
---|---|
Provider Name | Emily Anne Devol |
First Address | Columbus, OH 43231-7651 |
Second Address | Columbus, OH 43231-7651 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2016 |
Last Update Date | 27/03/2018 |