Provider Information for 1285247213
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DIANA DEVRIES
Sex: Female
NPI: 1285247213
Last Updated: 2023-11-29
Certification Date: 2023-11-29
Certification Date: 2023-11-29
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1285247213 | ||||||||||||
| Enumeration Date | 2020-08-28 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | N5813 1110TH ST PRESCOTT, WI 54021-7727 United States Phone: 715-441-0072 | Fax: | ||||||||||||
| Primary Practice Address | N5813 1110TH ST PRESCOTT, WI 54021-7727 United States Phone: 715-441-0072 | Fax: | ||||||||||||
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