Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RI0200X | Infectious Disease | 4301072914 | MI |
N | 207RI0200X | Infectious Disease | D0088533 | MD |
Y | 207RI0200X | Infectious Disease | MD201503 | OR |
NPI | 1013998509 |
---|---|
Provider Name | Roni Kristin Devlin |
First Address | Corvallis, OR 97339-1189 |
Second Address | Clinton, MD 20735 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 11/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H55861 | (02) | MI |