Individual
MARCIA DEVALK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CNS, MS
Contact information
Practice address
7066 STILLWATER BLVD N, OAKDALE, MN 55128-3937
(651) 777-5222
(651) 777-5222
Mailing address
7066 STILLWATER BLVD N, OAKDALE, MN 55128-3937
(651) 777-5222
(651) 777-5222
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1462896
MN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
035189102
MN
364SP0807X
Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
Primary
035189102
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
432686500
MEDICAL ASSISTANCE
MN
Enumeration date
11/22/2006
Last updated
08/10/2012
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