MISTY LYNN DEHAVEN APN NPI 1003384603

NPI Information

NPI: 1003384603
Provider Name: MISTY LYNN DEHAVEN, APN
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

Organization: JANE ADDAMS COMMUNITY MENTAL HEALTH CENTER

PECOS Registration: Yes

Address:
1639 N ALPINE RD STE 260
ROCKFORD, IL
ZIP 61107
Phone: (815) 395-1500
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Misty Lynn Dehaven, APN is a family nurse practitioner in Rockford, IL with 6 years of experience. Misty Lynn Dehaven, APN NPI is 1003384603. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1639 N ALPINE RD STE 260
ROCKFORD, IL
ZIP 61107-481
Phone: (815) 395-1500
Fax: (815) 395-1415

The NPI 1003384603 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 11/13/2018 and was last updated on 2/26/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	209018358	ILLINOIS	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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