Individual
DEVAN WALLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
747 BLUNK ST, PLYMOUTH, MI 48170-1165
(734) 620-4230
Mailing address
747 BLUNK ST, PLYMOUTH, MI 48170-1165
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704300496
MI
367500000X
Certified Registered Nurse Anesthetist
Primary
4704300496
MI
Other
Enumeration date
06/26/2023
Last updated
08/24/2023
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