Provider Demographics
NPI:1083321079
Name:DEVANE, BRITTANEY CAROLINE (NP)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANEY
Middle Name:CAROLINE
Last Name:DEVANE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BRITTANEY
Other - Middle Name:CAROLINE
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9181 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-5101
Mailing Address - Country:US
Mailing Address - Phone:952-457-8370
Mailing Address - Fax:
Practice Address - Street 1:2681 W. 78TH STREET
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317
Practice Address - Country:US
Practice Address - Phone:952-457-8370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9658363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner