Provider Demographics
NPI:1164878229
Name:DEVOUS, LAURA (FNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:DEVOUS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 S WELVER ST
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:IL
Mailing Address - Zip Code:62979-1403
Mailing Address - Country:US
Mailing Address - Phone:618-313-2023
Mailing Address - Fax:
Practice Address - Street 1:1405 LOCUST ST
Practice Address - Street 2:
Practice Address - City:ELDORADO
Practice Address - State:IL
Practice Address - Zip Code:62930-1629
Practice Address - Country:US
Practice Address - Phone:618-273-3321
Practice Address - Fax:618-273-3322
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014271363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner