1447408430 NPI number — ROBIN MICHELLE HAVENS C.N.P.

Table of content: ROBIN MICHELLE HAVENS C.N.P. (NPI 1447408430)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447408430 NPI number — ROBIN MICHELLE HAVENS C.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAVENS
Provider First Name:
ROBIN
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
C.N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAXTON
Provider Other First Name:
ROBIN
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
C.N.P.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447408430
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
424 WARDS CORNER RD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45140-6966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-707-4041
Provider Business Mailing Address Fax Number:
513-576-1020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
218 STERN DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEAMAN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45679-9607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-386-1379
Provider Business Practice Location Address Fax Number:
937-386-0129
Provider Enumeration Date:
09/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  NP-10189 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2889772 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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