Provider Demographics
NPI:1376227462
Name:DE HAVEN, KRISTEN
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:DE HAVEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GENEVIEVE
Other - Middle Name:YVONNE
Other - Last Name:DE HAVEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2606 SPENARD RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2309
Mailing Address - Country:US
Mailing Address - Phone:907-279-7669
Mailing Address - Fax:
Practice Address - Street 1:2606 SPENARD RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2309
Practice Address - Country:US
Practice Address - Phone:907-279-7669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program