Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 71011887A | IN |
NPI | 1336805258 |
---|---|
Provider Name | Madeline Rae Devore |
First Address | Indianapolis, IN 46260-2479 |
Second Address | Indianapolis, IN 46260-2479 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2021 |
Last Update Date | 15/11/2021 |