Provider Demographics
NPI:1811714678
Name:HAVENS, MELISSA N (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:N
Last Name:HAVENS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 LINCOLN AVE STE 13B
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-3063
Mailing Address - Country:US
Mailing Address - Phone:559-355-7464
Mailing Address - Fax:
Practice Address - Street 1:1275 LINCOLN AVE STE 13B
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-3063
Practice Address - Country:US
Practice Address - Phone:408-852-3304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032292363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health