Provider Demographics
NPI:1235279407
Name:HAVENS, LAUREN JO (MSN, FNP)
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:JO
Last Name:HAVENS
Suffix:
Gender:F
Credentials:MSN, FNP
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Mailing Address - Street 1:4001 E GENESEE ST
Mailing Address - Street 2:APT 110
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13214-2144
Mailing Address - Country:US
Mailing Address - Phone:315-729-5064
Mailing Address - Fax:
Practice Address - Street 1:4939 BRITTONFIELD PKWY
Practice Address - Street 2:BLDG B SUITE 210
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9208
Practice Address - Country:US
Practice Address - Phone:315-471-8404
Practice Address - Fax:315-471-6803
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY334767363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily