Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 200350108NNP | OR |
N | 363LN0000X | Nurse Practitioner - Neonatal | 2007025927 | MO |
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP60148500 | WA |
N | 363LN0000X | Nurse Practitioner - Neonatal | R1777183 | MN |
NPI | 1215097795 |
---|---|
Provider Name | Susan L Mcdevitt |
First Address | Gig Harbor, WA 98335-5639 |
Second Address | Portland, OR 97239-3011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 19/01/2015 |