Provider Demographics
NPI:1225412869
Name:MILLER, DEVAN MARISSA (PA-C)
Entity Type:Individual
Prefix:
First Name:DEVAN
Middle Name:MARISSA
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DEVAN
Other - Middle Name:MARISSA
Other - Last Name:RAGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:841 STERLING PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-7324
Mailing Address - Country:US
Mailing Address - Phone:916-645-3388
Mailing Address - Fax:
Practice Address - Street 1:841 STERLING PKWY STE 120
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-7324
Practice Address - Country:US
Practice Address - Phone:916-645-3388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2023-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA58731363A00000X
PAMA057655363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant