Provider Demographics
NPI:1326514654
Name:DEAVOR, CHRISSY MICHAEL
Entity Type:Individual
Prefix:
First Name:CHRISSY
Middle Name:MICHAEL
Last Name:DEAVOR
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 1:1700 W WARLOW DR APT 309
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-2586
Mailing Address - Country:US
Mailing Address - Phone:307-620-5598
Mailing Address - Fax:
Practice Address - Street 1:1700 W WARLOW DR APT 309
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-2586
Practice Address - Country:US
Practice Address - Phone:307-620-5598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-14
Last Update Date:2018-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator