Healthcare Provider Details

I. General information

NPI: 1255258174
Provider Name (Legal Business Name): VICTORIA HAUBRICH DNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 VERMONT ST
QUINCY IL
62301-3754
US

IV. Provider business mailing address

250 VERMONT ST
QUINCY IL
62301
US

V. Phone/Fax

Practice location:
  • Phone: 217-779-8686
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.035915
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: