Provider Demographics
NPI:1720368699
Name:CARROLL, DEVON PETERSON (APRN)
Entity Type:Individual
Prefix:MISS
First Name:DEVON
Middle Name:PETERSON
Last Name:CARROLL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 ARNOLD CIR STE 7
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-2250
Mailing Address - Country:US
Mailing Address - Phone:617-397-4737
Mailing Address - Fax:617-362-5424
Practice Address - Street 1:1 ARNOLD CIR STE 7
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-2250
Practice Address - Country:US
Practice Address - Phone:617-397-4737
Practice Address - Fax:617-362-5424
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2271345363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health