Provider Demographics
NPI:1437197050
Name:DEVINE, NANCY CLAIRE (MD)
Entity Type:Individual
Prefix:MISS
First Name:NANCY
Middle Name:CLAIRE
Last Name:DEVINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2272 E APPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442
Mailing Address - Country:US
Mailing Address - Phone:231-747-7530
Mailing Address - Fax:231-747-7531
Practice Address - Street 1:2272 E. APPLE AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442
Practice Address - Country:US
Practice Address - Phone:231-728-4797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010828752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4559952Medicaid
MI260F110140OtherBCBSM
MI260F110140OtherBCBSM
MI4559952Medicaid
OP60470001Medicare PIN