Provider Demographics
NPI:1891008462
Name:DEVILLE, STEVEN JOSEPH (NPC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JOSEPH
Last Name:DEVILLE
Suffix:
Gender:M
Credentials:NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18470 HIGHWAY 175
Mailing Address - Street 2:
Mailing Address - City:MANY
Mailing Address - State:LA
Mailing Address - Zip Code:71449-6020
Mailing Address - Country:US
Mailing Address - Phone:337-304-4553
Mailing Address - Fax:
Practice Address - Street 1:395 S CAPITOL ST
Practice Address - Street 2:
Practice Address - City:MANY
Practice Address - State:LA
Practice Address - Zip Code:71449-3049
Practice Address - Country:US
Practice Address - Phone:318-256-1136
Practice Address - Fax:318-256-6237
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LATEMPORARY363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LATEMPORARYOtherLA STATE BOARD NURSING