Provider Demographics
NPI:1336360676
Name:DEVINE, NICOLE KRISHNA (CNM)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:KRISHNA
Last Name:DEVINE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4685 FOREST AVE
Mailing Address - Street 2:STE C
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3359
Mailing Address - Country:US
Mailing Address - Phone:513-569-6117
Mailing Address - Fax:513-852-8525
Practice Address - Street 1:3440 BURNET AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-2833
Practice Address - Country:US
Practice Address - Phone:513-751-5900
Practice Address - Fax:513-487-4590
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNM-08389367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife