Provider Demographics
NPI:1649754383
Name:BURWELL, DEVANN ELAINE
Entity Type:Individual
Prefix:
First Name:DEVANN
Middle Name:ELAINE
Last Name:BURWELL
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 1:6918 SUNDEW CRK
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-3444
Mailing Address - Country:US
Mailing Address - Phone:269-240-4244
Mailing Address - Fax:
Practice Address - Street 1:3488 GARDEN AVE
Practice Address - Street 2:ANDERSON HALL MIF 4 FORT SAM HOUSTON
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78109
Practice Address - Country:US
Practice Address - Phone:269-240-4244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians