Provider Demographics
NPI:1407981103
Name:HAVENS, JANET (RD, CDE)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:HAVENS
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:
Other - Last Name:NIESET
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3666 S STATE RD
Mailing Address - Street 2:
Mailing Address - City:HARBOR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49740-9711
Mailing Address - Country:US
Mailing Address - Phone:231-526-6186
Mailing Address - Fax:
Practice Address - Street 1:416 CONNABLE AVE
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2212
Practice Address - Country:US
Practice Address - Phone:231-487-4894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN85940001Medicare ID - Type Unspecified