Provider Demographics
NPI:1013919067
Name:DEVEAUX, THERESA EILEEN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:EILEEN
Last Name:DEVEAUX
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061
Mailing Address - Country:US
Mailing Address - Phone:410-553-8300
Mailing Address - Fax:410-553-8349
Practice Address - Street 1:301 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5803
Practice Address - Country:US
Practice Address - Phone:410-553-8300
Practice Address - Fax:410-553-8349
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR093166363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCF591 0008OtherCAREFIRST BLUE CROSS DC
MD4992OtherBRAVO/ELDER HEALTH
MD61740701OtherCAREFIRST BLUE CROSS MD
MD400067600Medicaid
MD107423OtherAMERIGROUP
MD22500900OtherCIGNA
MD400067600Medicaid
DCF591 0008OtherCAREFIRST BLUE CROSS DC
MD4992OtherBRAVO/ELDER HEALTH