Provider Demographics
NPI:1669130415
Name:HAVRDA, TERRIE LEE
Entity type:Individual
Prefix:
First Name:TERRIE
Middle Name:LEE
Last Name:HAVRDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 COUNT AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-8630
Mailing Address - Country:US
Mailing Address - Phone:702-778-7440
Mailing Address - Fax:702-463-7527
Practice Address - Street 1:517 COUNT AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-8630
Practice Address - Country:US
Practice Address - Phone:702-778-7440
Practice Address - Fax:702-463-7527
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant