Provider Demographics
NPI:1114153814
Name:DEVINE, AMY LOUISE
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LOUISE
Last Name:DEVINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 CALLE PORTAL STE 100
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2900
Mailing Address - Country:US
Mailing Address - Phone:520-515-8673
Mailing Address - Fax:520-515-8663
Practice Address - Street 1:155 CALLE PORTAL STE 100
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635
Practice Address - Country:US
Practice Address - Phone:520-515-8673
Practice Address - Fax:520-515-8663
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZS020485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAHP215208OtherACE AMERICAN INSURANCE COMPANY PHILADELPHIA, PA