Provider Demographics
NPI:1871824755
Name:DEVRIES, JANE JOAN (PHARMD, RD, CDE)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:JOAN
Last Name:DEVRIES
Suffix:
Gender:F
Credentials:PHARMD, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 BLYKEFORD LN
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-8038
Mailing Address - Country:US
Mailing Address - Phone:901-299-4220
Mailing Address - Fax:
Practice Address - Street 1:350 E SIX FORKS RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7879
Practice Address - Country:US
Practice Address - Phone:919-832-1803
Practice Address - Fax:919-828-5265
Is Sole Proprietor?:No
Enumeration Date:2010-01-16
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS010364183500000X
VA0202211262183500000X
NC22323183500000X
NCL003965133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No183500000XPharmacy Service ProvidersPharmacist