Most Relevant Information
Provider Data
| NPI Number: | 1003384603 |
| Provider Name: | MISTY LYNN DEHAVEN APN |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 209018358 |
Most Important Dates
| Enumeration Date: | 11/13/2018 |
| Last Updated: | 02/26/2019 |
Provider Practice Location
1639 N ALPINE RD STE 260
ROCKFORD
IL
611071481
Practice Location Phone/Fax
| Phone: | 8153951500 |
| Fax: | 8153951415 |
Provider Mailing Location
PO BOX 957
ROCKFORD
IL
611050957
Provider Mailing Phone/Fax
| Phone: | 8153951500 |
| Fax: | 8153951415 |