Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 8518 | MN |
NPI | 1093397085 |
---|---|
Provider Name | Ms. Theresa C Mcdevitt |
First Address | Edina, MN 55435-2197 |
Second Address | Edina, MN 55435-2197 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2021 |
Last Update Date | 13/09/2021 |