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Individual
MS. CRYSTAL MARIE DEVIVO
Active
Individual
MS. CRYSTAL MARIE DEVIVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
821
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1055040
NCCPA CERTIFICATION
—
05
—
1115PA
—
SC
Enumeration date
05/11/2009
Last updated
11/20/2017
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