Individual
JOHANNA DEVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2003 MEDICAL PKWY STE 150, ANNAPOLIS, MD 21401-0317
(443) 481-1199
(443) 481-1495
Mailing address
2001 MEDICAL PKWY, MEDICAL STAFF OFFICE, ANNAPOLIS, MD 21401-8391
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R201720
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
747365
MEDICARE
MD
05
—
777675600
—
MD
Enumeration date
08/23/2018
Last updated
01/02/2019
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