Provider Demographics
NPI:1447443619
Name:DEVIN DENNIS
Entity type:Organization
Organization Name:DEVIN DENNIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:ELISABETH
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-973-0099
Mailing Address - Street 1:429 RIVER LN
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO DOWNS
Mailing Address - State:NM
Mailing Address - Zip Code:88346
Mailing Address - Country:US
Mailing Address - Phone:505-059-7300
Mailing Address - Fax:
Practice Address - Street 1:429 RIVER LN
Practice Address - Street 2:
Practice Address - City:RUIDOSO DOWNS
Practice Address - State:NM
Practice Address - Zip Code:88346
Practice Address - Country:US
Practice Address - Phone:505-973-0099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization