Provider Demographics
NPI:1982336681
Name:O'HAVER, AUBRIE ANN ELAINE
Entity Type:Individual
Prefix:
First Name:AUBRIE
Middle Name:ANN ELAINE
Last Name:O'HAVER
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 1:705 BRADY ST APT 1
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-5240
Mailing Address - Country:US
Mailing Address - Phone:563-505-9525
Mailing Address - Fax:
Practice Address - Street 1:12160 S UTAH AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-9537
Practice Address - Country:US
Practice Address - Phone:563-326-1150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician