Provider Demographics
NPI:1922321066
Name:HAVE NP WILL TRAVEL INC
Entity Type:Organization
Organization Name:HAVE NP WILL TRAVEL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:STEEVES
Authorized Official - Last Name:CROTEAU
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:760-948-7404
Mailing Address - Street 1:7245 JENKINS AVE
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-7216
Mailing Address - Country:US
Mailing Address - Phone:760-948-7404
Mailing Address - Fax:760-948-7404
Practice Address - Street 1:15555 MAIN ST
Practice Address - Street 2:SUITE D4
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3466
Practice Address - Country:US
Practice Address - Phone:760-948-7404
Practice Address - Fax:760-948-7404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA317876252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA317876OtherADULT NURSE PRACTITIONER