Devivo, Crystal Marie

Devivo, Crystal Marie is an individual health care provider with primary practice located at 216 Edgefield Ave Nw , Aiken SC 29801-3910. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Devivo, Crystal Marie can be contacted via phone (803) 648-4224.

Contact Information

Primary practice address
216 Edgefield Ave Nw Aiken SC 29801-3910
Phone: (803) 648-4224
Fax: (803) 641-7600
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 821 South Carolina

Profile Details

NPI number 1265666861
LBN Legal business name Devivo, Crystal Marie
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date May 11th, 2009
Last updated Nov 20th, 2017 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265666861 NPPES
Other 1055040 NCCPA CERTIFICATION
MEDICAID 1115PA NCCPA CERTIFICATION

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