Provider Demographics
NPI:1265772842
Name:DEVRIES, JUSTINE (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:
Last Name:DEVRIES
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 POMONA AVE
Mailing Address - Street 2:
Mailing Address - City:PORT REPUBLIC
Mailing Address - State:NJ
Mailing Address - Zip Code:08241-9748
Mailing Address - Country:US
Mailing Address - Phone:609-709-0578
Mailing Address - Fax:609-296-1624
Practice Address - Street 1:137 POMONA AVE
Practice Address - Street 2:
Practice Address - City:PORT REPUBLIC
Practice Address - State:NJ
Practice Address - Zip Code:08241-9748
Practice Address - Country:US
Practice Address - Phone:609-709-0578
Practice Address - Fax:609-296-1624
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-19
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR14542700163W00000X, 163WS0200X
NJ246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WS0200XNursing Service ProvidersRegistered NurseSchool
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy