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General NPI Number Information
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NPI Number | 1164878229
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Entity Type | Individual
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Provider Name | LAURA DEVOUS FNP
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Gender | Female
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Dates
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Enumeration Date | 05/09/2016
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Last Update Date | 05/09/2016
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Provider Practice Location Address
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Address Line | 1405 LOCUST ST
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City | ELDORADO
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State | IL
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Zip | 62930-1629
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Country | US
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Telephone | 618-273-3321
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Fax | 618-273-3322
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Provider Business Mailing Address
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Address Line | 429 S WELVER ST
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City | RIDGWAY
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State | IL
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Zip | 62979-1403
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Country | US
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Telephone | 618-313-2023
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209014271
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License Number State | IL
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