Provider Demographics
NPI:1659441616
Name:HAVENS, TERRY L (FNP-C)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:HAVENS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4214
Mailing Address - Country:US
Mailing Address - Phone:812-242-3130
Mailing Address - Fax:812-242-3596
Practice Address - Street 1:1429 N 6TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-1037
Practice Address - Country:US
Practice Address - Phone:812-242-3130
Practice Address - Fax:812-242-3596
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002151A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00828501OtherRAILROAD MEDICARE
IN200816550Medicaid
INP00752971OtherRAILROAD MEDICARE
IN859910C5Medicare PIN
INP00752971OtherRAILROAD MEDICARE
IN192770YYYYMedicare PIN