Provider Demographics
NPI:1255771911
Name:DEVINE, TERESA JANE (MD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:JANE
Last Name:DEVINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 HIGHWAY 25 N
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-1930
Mailing Address - Country:US
Mailing Address - Phone:763-682-1313
Mailing Address - Fax:763-581-9090
Practice Address - Street 1:1001 HART BLVD
Practice Address - Street 2:STE 100
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-8670
Practice Address - Country:US
Practice Address - Phone:763-295-2921
Practice Address - Fax:763-271-3807
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN58006207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine