Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 35088762 | OH |
N | 208000000X | Pediatrician | 37245 | IA |
NPI | 1003025016 |
---|---|
Provider Name | Erica Devries |
First Address | Toledo, OH 43606-3895 |
Second Address | Toledo, OH 43606-3895 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 26/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003025016 | (05) | IA |