Provider Demographics
NPI:1912073438
Name:HAVIN, JENNIFER S
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:HAVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6404 S LATAH HILLS CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-8530
Mailing Address - Country:US
Mailing Address - Phone:509-481-0487
Mailing Address - Fax:509-228-9542
Practice Address - Street 1:6404 S LATAH HILLS CT
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-8530
Practice Address - Country:US
Practice Address - Phone:509-481-0487
Practice Address - Fax:509-228-9542
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007512367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP30007512OtherLICENSE