Provider Demographics
NPI:1609122175
Name:DEVINE, ELIZABETH A (APRN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:DEVINE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 E 4TH ST
Mailing Address - Street 2:STE A
Mailing Address - City:AINSWORTH
Mailing Address - State:NE
Mailing Address - Zip Code:69210-1207
Mailing Address - Country:US
Mailing Address - Phone:402-382-3600
Mailing Address - Fax:
Practice Address - Street 1:843 E 4TH ST STE A
Practice Address - Street 2:
Practice Address - City:AINSWORTH
Practice Address - State:NE
Practice Address - Zip Code:69210-1216
Practice Address - Country:US
Practice Address - Phone:402-382-3555
Practice Address - Fax:402-382-3556
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111402363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026257700Medicaid
NE10026257700Medicaid