Provider Demographics
NPI:1952835910
Name:HAUB, DEVIN RENEE (FNP-C)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:RENEE
Last Name:HAUB
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:DEVIN
Other - Middle Name:RENEE
Other - Last Name:RUDOLPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15096 LAMINACK RD
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-3022
Mailing Address - Country:US
Mailing Address - Phone:618-922-2840
Mailing Address - Fax:
Practice Address - Street 1:201 S 14TH ST
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3631
Practice Address - Country:US
Practice Address - Phone:618-942-2171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015854363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily