Healthcare Provider Details

I. General information

NPI: 1558300780
Provider Name (Legal Business Name): DEANNE M HOBERT APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 28TH AVENUE DR
MOLINE IL
61265-5536
US

IV. Provider business mailing address

3900 28TH AVENUE DR
MOLINE IL
61265-5536
US

V. Phone/Fax

Practice location:
  • Phone: 309-281-2840
  • Fax:
Mailing address:
  • Phone: 309-281-2840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number041-254207
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: