Provider Demographics
NPI:1093397085
Name:MCDEVITT, THERESA C (CNP, WHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:C
Last Name:MCDEVITT
Suffix:
Gender:F
Credentials:CNP, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 W 66TH ST STE 385
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2197
Mailing Address - Country:US
Mailing Address - Phone:952-927-6561
Mailing Address - Fax:
Practice Address - Street 1:3400 W 66TH ST STE 385
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2197
Practice Address - Country:US
Practice Address - Phone:952-927-6561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0998242-NP363LW0102X, 363L00000X
MN8518363LW0102X
MN2086909163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner