Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 5009379 | NC |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 112047 | NE |
NPI | 1366992273 |
---|---|
Provider Name | Michele Devita |
First Address | Fayetteville, NC 28309 |
Second Address | Pinehurst, NC 28374-8710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2016 |
Last Update Date | 29/04/2019 |