Individual
PENNY DEVRIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
524 W CENTRE AVE, PORTAGE, MI 49024-5306
(269) 324-1180
Mailing address
2112 W OSTERHOUT AVE, PORTAGE, MI 49024-6720
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703084682
MI
Other
Enumeration date
07/27/2018
Last updated
07/27/2018
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