Provider Demographics
NPI:1932652641
Name:HAVENS, JESSICA MARY EVELYN (DNP)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MARY EVELYN
Last Name:HAVENS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 POLLUX RD
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-8264
Mailing Address - Country:US
Mailing Address - Phone:970-216-9299
Mailing Address - Fax:
Practice Address - Street 1:1105 POLLUX RD
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-8264
Practice Address - Country:US
Practice Address - Phone:970-216-9299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-104039363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily