Provider Demographics
NPI:1063639789
Name:HAVENS, KATHLEEN JOYCE (RN, BSN)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:JOYCE
Last Name:HAVENS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 E VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-3510
Mailing Address - Country:US
Mailing Address - Phone:520-745-5613
Mailing Address - Fax:520-745-5613
Practice Address - Street 1:3233 S PINAL VIS
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-6554
Practice Address - Country:US
Practice Address - Phone:520-225-3517
Practice Address - Fax:520-225-3515
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN069123163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ684614OtherAHCCCS