Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | APRN.CNP.0026917 | OH |
NPI | 1003350943 |
---|---|
Provider Name | Mrs. Jaimie Ann Devine |
First Address | Lima, OH 45801-4332 |
Second Address | Toledo, OH 43615-5164 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2016 |
Last Update Date | 19/08/2020 |