Provider Demographics
NPI:1811702590
Name:HAVENS, DALLAS
Entity type:Individual
Prefix:MR
First Name:DALLAS
Middle Name:
Last Name:HAVENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 N 83RD ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68507-3395
Mailing Address - Country:US
Mailing Address - Phone:402-902-9745
Mailing Address - Fax:
Practice Address - Street 1:2421 N 83RD ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68507-3395
Practice Address - Country:US
Practice Address - Phone:402-902-9745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care