Provider Demographics
NPI:1720629066
Name:HAVENS, JESSE ROCHELLE (RN)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:ROCHELLE
Last Name:HAVENS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 NW 65TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-5531
Mailing Address - Country:US
Mailing Address - Phone:206-252-1727
Mailing Address - Fax:
Practice Address - Street 1:1810 NW 65TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-5531
Practice Address - Country:US
Practice Address - Phone:206-252-1727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60970621163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool