Provider Demographics
NPI:1467508655
Name:DEVERNOE, MARTHA JEAN (RN)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:JEAN
Last Name:DEVERNOE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9102 KINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-2244
Mailing Address - Country:US
Mailing Address - Phone:941-761-2393
Mailing Address - Fax:941-761-2393
Practice Address - Street 1:9102 KINGSTON RD
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-2244
Practice Address - Country:US
Practice Address - Phone:941-761-2393
Practice Address - Fax:941-761-2393
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLRN3311102163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics