Provider Demographics
NPI:1568181394
Name:DEVONE, MARISHA JONELLE
Entity Type:Individual
Prefix:MISS
First Name:MARISHA
Middle Name:JONELLE
Last Name:DEVONE
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 1:105 GLENDALE VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:WALLACE
Mailing Address - State:NC
Mailing Address - Zip Code:28466-1651
Mailing Address - Country:US
Mailing Address - Phone:910-627-6574
Mailing Address - Fax:
Practice Address - Street 1:105 GLENDALE VILLAGE LN
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:NC
Practice Address - Zip Code:28466-1651
Practice Address - Country:US
Practice Address - Phone:910-627-6574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC171M00000X
171M00000X, 174400000X
NC488295376K00000X
NCP525342146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174400000XOther Service ProvidersSpecialist
No376K00000XNursing Service Related ProvidersNurse's Aide