1578869525 NPI number — MRS. JESSICA LYNNE DEVINE CRNA

Table of content: MRS. JESSICA LYNNE DEVINE CRNA (NPI 1578869525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578869525 NPI number — MRS. JESSICA LYNNE DEVINE CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEVINE
Provider First Name:
JESSICA
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BURNS
Provider Other First Name:
JESSICA
Provider Other Middle Name:
LYNNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578869525
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 E NORTH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15212-4756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-359-6581
Provider Business Mailing Address Fax Number:
412-359-3483

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2570 HAYMAKER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROEVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15146-3513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-578-5323
Provider Business Practice Location Address Fax Number:
412-578-4981
Provider Enumeration Date:
02/08/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RN577543 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 102561490 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".