Provider Demographics
NPI:1528218930
Name:UPDEGRAFF, DEVON NICOLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:DEVON
Middle Name:NICOLE
Last Name:UPDEGRAFF
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:13000 N 103RD AVE
Mailing Address - Street 2:SUITE 60
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3024
Mailing Address - Country:US
Mailing Address - Phone:623-933-3107
Mailing Address - Fax:623-972-1418
Practice Address - Street 1:13000 N 103RD AVE
Practice Address - Street 2:SUITE 60
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3024
Practice Address - Country:US
Practice Address - Phone:623-933-3107
Practice Address - Fax:623-972-1418
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2015-02-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ4219363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant