1912073438 NPI number — JENNIFER S HAVIN

Table of content: JENNIFER S HAVIN (NPI 1912073438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912073438 NPI number — JENNIFER S HAVIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAVIN
Provider First Name:
JENNIFER
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARTER
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912073438
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6404 S LATAH HILLS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99224-8530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-481-0487
Provider Business Mailing Address Fax Number:
509-228-9542

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6404 S LATAH HILLS CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99224-8530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-481-0487
Provider Business Practice Location Address Fax Number:
509-228-9542
Provider Enumeration Date:
11/27/2006

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: 367500000X , with the licence number:  AP30007512 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AP30007512 . This is a "LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".