Provider Demographics
NPI:1649586819
Name:HABING, BERNARD H (FNP)
Entity Type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:H
Last Name:HABING
Suffix:
Gender:M
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:PO BOX 19248
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9248
Mailing Address - Country:US
Mailing Address - Phone:217-528-7541
Mailing Address - Fax:
Practice Address - Street 1:206 N PEARL ST
Practice Address - Street 2:
Practice Address - City:TEUTOPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62467-1134
Practice Address - Country:US
Practice Address - Phone:217-857-6481
Practice Address - Fax:217-857-6094
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008316363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF0610073OtherAANP CERTIFICATION
IL209008316OtherSTATE OF IL
IL041290665OtherRN LICENSE
IL148962Medicare Oscar/Certification