Provider Demographics
NPI:1770557142
Name:DEVINE, CATHERINE M (NP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:DEVINE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3628
Mailing Address - Country:US
Mailing Address - Phone:173-252-8006
Mailing Address - Fax:
Practice Address - Street 1:291 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-3628
Practice Address - Country:US
Practice Address - Phone:173-252-8006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA201098363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP3858OtherBLUE CROSS
MAAA31648OtherHARVARD PILGRIM
MA0703192Medicaid
MA0703192Medicaid
MANP3858Medicare ID - Type Unspecified