Provider Demographics
NPI:1841576220
Name:VAN BRIESEN, DEVIN
Entity Type:Individual
Prefix:MRS
First Name:DEVIN
Middle Name:
Last Name:VAN BRIESEN
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:PO BOX 455
Mailing Address - Street 2:
Mailing Address - City:SHELDON
Mailing Address - State:IA
Mailing Address - Zip Code:51201-0455
Mailing Address - Country:US
Mailing Address - Phone:712-324-4331
Mailing Address - Fax:
Practice Address - Street 1:610 PARK ST
Practice Address - Street 2:
Practice Address - City:SHELDON
Practice Address - State:IA
Practice Address - Zip Code:51201-1202
Practice Address - Country:US
Practice Address - Phone:712-324-4331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119790183500000X
SD5675183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist