Provider Demographics
NPI:1568554350
Name:DEVLIN-SAMPLE, ELLEN (FNP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:DEVLIN-SAMPLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:DEVLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:514 FIRST AVE
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-1107
Mailing Address - Country:US
Mailing Address - Phone:914-632-5156
Mailing Address - Fax:612-659-7101
Practice Address - Street 1:514 FIRST AVE
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-1107
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:612-659-7101
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332094-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily