MISTY LYNN DEHAVEN (NPI# 1003384603) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003384603 |
| Entity Type | Individual |
| Full Name | MISTY LYNN DEHAVEN |
| Credential | APN |
| Practice Address |
1639 N Alpine Rd Ste 260 Rockford IL 61107-1481 |
| Mailing Address |
Po Box 957 Rockford IL 61105-0957 |
| Practice Telephone | 8153951500 |
| Practice Fax Number | 8153951415 |
| Mailing Telephone | 8153951500 |
| Mailing Fax Number | 8153951415 |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2019-02-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
209018358 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1639 N ALPINE RD STE 260 |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61107-1481 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063492718 | Sandy Meade | Nurse Practitioner | 1639 N Alpine Rd Ste 260, Rockford, IL 61107-1481 | 2006-01-19 |
| 1326548330 | Gena Whitson | Counselor | 1639 N Alpine Rd Ste 260, Rockford, IL 61107-1481 | 2018-02-16 |
| 1649662453 | Rachel Rothermel | Marriage & Family Therapist | 1639 N Alpine Rd Ste 260, Rockford, IL 61107-1481 | 2015-03-03 |
| 1821391442 | Rockford Psychiatric Medical Services Sc | Psychiatry & Neurology | 1639 N Alpine Rd Ste 260, Rockford, IL 61107-1481 | 2010-12-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356952139 | Jessica Marie Tamayo Fernandez | Pharmacist | 1145 Alpine Rd, Rockford, IL 61107 | 2020-08-13 |
| 1467092379 | Unknown Safa Fatima | Student in an Organized Health Care Education/Training Program | Mercyhealth Mulford Clinic, 5970 Churchview Drive, Rockford, IL 61107 | 2020-01-08 |
| 1194367912 | Matt J Kriebs | Nurse Practitioner | 1235 N Mulford Rd Suite 103, Rockford, IL 61107 | 2019-10-14 |
| 1265962336 | Mary Golembeck | Nurse Practitioner | 7290 Argus Dr, Rockford, IL 61107 | 2017-06-12 |
| 1831644749 | Tessa Lee | Occupational Therapist | 3422 Lauderdale Ln, Rockford, IL 61107 | 2016-08-20 |
| 1942626965 | Elevated Health Essentials, LLC | Chiropractor | 124 N Water St Ste 204e, Rockford, IL 61107 | 2014-03-14 |
| 1093139909 | Swedishamerican Hospital | Surgery | 1639 N Alpine Rd Ste 400, Rockford, IL 61107 | 2014-02-12 |
| 1346676582 | Christopher Anthony Ziganto | Pharmacist | 494 Bienterra Trail #2, Rockford, IL 61107 | 2013-09-19 |
| 1023358272 | Lavanya Durairajan | Physical Therapist | 7358 Shiligton Dr, Rockford, IL 61107 | 2013-02-26 |
| 1851523146 | Great Smiles of Rockford | Durable Medical Equipment & Medical Supplies | 780 N. Mulfrord Road, Rockford, IL 61107 | 2009-08-20 |
| Find all providers in zip 61107 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174138481 | Kelly Ann Twigg | Nurse Practitioner | 5669 Shelley Rd, Rockford, OH 45882-9577 | 2020-09-14 |
| 1699389882 | Mary Ann Shaw | Nurse Practitioner | 207 W Main Ave, Rockford, IA 50468-1213 | 2020-09-04 |
| 1124632922 | Catherine Nwosu | Nurse Practitioner | 3455 Holiday Dr Apt 10, Rockford, IL 61109-2489 | 2020-08-31 |
| 1790314631 | Toni A Hughart | Nurse Practitioner | 6000 E State St, Rockford, IL 61108-2521 | 2020-04-03 |
| 1578199220 | Keli S Griseta | Nurse Practitioner | 3505 N Bell School Rd, Rockford, IL 61114-6624 | 2020-03-13 |
| 1457986069 | Nicole P Falatic | Nurse Practitioner | 153 Glen Eagle Dr Ne, Rockford, MI 49341-1183 | 2020-03-04 |
| 1194367912 | Matt J Kriebs | Nurse Practitioner | 1235 N Mulford Rd Suite 103, Rockford, IL 61107 | 2019-10-14 |
| 1952869943 | Angela Marie Hawkins | Nurse Practitioner | 8201 E. Riverside Blvd, Pediatric Neurology, Rockford, IL 61114 | 2019-03-08 |
| 1487110540 | Karrie Hagger | Nurse Practitioner | 7476 Countryshire Ln, Rockford, IL 61107-2774 | 2019-02-13 |
| 1336652700 | Stacey Jo Caler | Nurse Practitioner | 363 Financial Ct Unit 300, Rockford, IL 61107-6671 | 2017-11-08 |
| Find all providers in ROCKFORD | ||||
Please comment or provide details below to improve the information on MISTY LYNN DEHAVEN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.