Provider Demographics
NPI:1376926535
Name:DEVINE, REBECCA (DNP, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:DEVINE
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 NE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:LEON
Mailing Address - State:IA
Mailing Address - Zip Code:50144-1206
Mailing Address - Country:US
Mailing Address - Phone:641-446-2383
Mailing Address - Fax:
Practice Address - Street 1:302 NE 14TH ST
Practice Address - Street 2:
Practice Address - City:LEON
Practice Address - State:IA
Practice Address - Zip Code:50144-1206
Practice Address - Country:US
Practice Address - Phone:641-446-2383
Practice Address - Fax:515-777-1295
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG120399363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health