1376982157 NPI number — MRS. EVA ROSEANNE MARTINEZ-DEVOURSNEY LLP, LLPC, CAADC

Table of content: MRS. EVA ROSEANNE MARTINEZ-DEVOURSNEY LLP, LLPC, CAADC (NPI 1376982157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376982157 NPI number — MRS. EVA ROSEANNE MARTINEZ-DEVOURSNEY LLP, LLPC, CAADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINEZ-DEVOURSNEY
Provider First Name:
EVA
Provider Middle Name:
ROSEANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LLP, LLPC, CAADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376982157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
885 OAKRIDGE RD
Provider Second Line Business Mailing Address:
MUSKEGON
Provider Business Mailing Address City Name:
NORTON SHORES
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49444-3719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-780-8252
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
885 OAKRIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUSKEGON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49441-4023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-780-8252
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
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Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X , with the licence number:  6301012846 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: #6401009354 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)