Provider Demographics
NPI:1619513363
Name:HAVILI, ATUNAISA O
Entity Type:Individual
Prefix:
First Name:ATUNAISA
Middle Name:O
Last Name:HAVILI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3023 N BRONZEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:ERDA
Mailing Address - State:UT
Mailing Address - Zip Code:84074-3302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3023 N BRONZEWOOD CIR
Practice Address - Street 2:
Practice Address - City:ERDA
Practice Address - State:UT
Practice Address - Zip Code:84074-3302
Practice Address - Country:US
Practice Address - Phone:435-255-7650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker