Provider Demographics
NPI:1093837023
Name:NICHOLL-EWERT, DEVON (MPH, MOT)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:NICHOLL-EWERT
Suffix:
Gender:F
Credentials:MPH, MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 SW 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-4036
Mailing Address - Country:US
Mailing Address - Phone:954-554-6016
Mailing Address - Fax:
Practice Address - Street 1:719 SW 42ND AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-4036
Practice Address - Country:US
Practice Address - Phone:954-554-6016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT8420174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist