Provider Demographics
NPI:1477096998
Name:DEVINE, JULIE (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:DEVINE
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:DEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-CNP
Mailing Address - Street 1:118 DOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2305
Mailing Address - Country:US
Mailing Address - Phone:937-593-5437
Mailing Address - Fax:
Practice Address - Street 1:118 DOWELL AVE
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-2305
Practice Address - Country:US
Practice Address - Phone:937-593-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020214363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0198723Medicaid
OH0198723Medicaid
OH1184652539OtherGROUP NPI - JTDM FAMILY PRACTICE, LLC
OH34-1689161OtherGROUP TAX ID - JTDM FAMILY PRACTICE, LLC