Provider Demographics
NPI:1235713215
Name:DEVERMONT, BLAIR ALLISON (APRN)
Entity Type:Individual
Prefix:MRS
First Name:BLAIR
Middle Name:ALLISON
Last Name:DEVERMONT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 13TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-2224
Mailing Address - Country:US
Mailing Address - Phone:202-679-2551
Mailing Address - Fax:
Practice Address - Street 1:700 PENNSYLVANIA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-2493
Practice Address - Country:US
Practice Address - Phone:202-446-1085
Practice Address - Fax:202-446-1086
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1030150163W00000X
DCNP1030150363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health