Active NPI
Georgia Devries, CNP
- Nurse Practitioner
- Detroit, MI
National Provider Identifier
1679019822
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 4704286497
- Practice address
- 4100 John R St
Detroit, MI 48201-2013 - Phone
- (800) 527-6266
- Fax
- (313) 576-8381
- NPI assigned
- Jan 12, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 4704286497 | MI | Primary |
Addresses
Primary practice location
4100 John R St
Detroit, MI 48201-2013
Mailing address
1560 E Maple Rd
Suite - 400 Credentialing
Troy, MI 48083-1138
Phone (800) 527-6266
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1484179200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1484179200000",
"number": "1679019822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1560 E MAPLE RD",
"address_2": "SUITE - 400 CREDENTIALING",
"city": "TROY",
"state": "MI",
"postal_code": "480831138",
"telephone_number": "800-527-6266",
"fax_number": "313-576-8381"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4100 JOHN R ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482012013",
"telephone_number": "800-527-6266",
"fax_number": "313-576-8381"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEVRIES",
"first_name": "GEORGIA",
"credential": "CNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-01-12",
"last_updated": "2017-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MI",
"license": "4704286497",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.