MEDICARE: JENNIFER S HAVIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	AP30007512	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP30007512	OTHER	WA	LICENSE

General Provider Information

NPI Number	:	1912073438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER S HAVIN

Provider Business Mailing Address
First Line	:	6404 S LATAH HILLS CT
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99224-8530
Country	:	US
Telephone Number	:	509-481-0487
Fax Number	:	509-228-9542

Provider Business Practice Location Address
First Line	:	6404 S LATAH HILLS CT
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99224-8530
Country	:	US
Telephone Number	:	509-481-0487
Fax Number	:	509-228-9542

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	02/09/2015

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