Provider Demographics
NPI:1043055338
Name:DEVA WELLNESS PLLC
Entity type:Organization
Organization Name:DEVA WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, FNP-X
Authorized Official - Prefix:
Authorized Official - First Name:TAMRA
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:GERYK
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-C
Authorized Official - Phone:413-687-3027
Mailing Address - Street 1:4280 N GINZEL ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-4214
Mailing Address - Country:US
Mailing Address - Phone:413-687-3027
Mailing Address - Fax:
Practice Address - Street 1:1620 W BANNOCK ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5156
Practice Address - Country:US
Practice Address - Phone:208-918-2242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty