Provider Demographics
NPI:1073363008
Name:DYSON, DEVONNA MARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:DEVONNA
Middle Name:MARIE
Last Name:DYSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 COLISEUM XING # 3570
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5971
Mailing Address - Country:US
Mailing Address - Phone:757-818-0213
Mailing Address - Fax:
Practice Address - Street 1:51 N LAKE LOOP
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5560
Practice Address - Country:US
Practice Address - Phone:757-818-0213
Practice Address - Fax:757-703-1528
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA001241631163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse