MEDICARE: VIOLET HAVENAR

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	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1962298752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIOLET HAVENAR

Provider Business Mailing Address
First Line	:	1306 GARFIELD ST
Second Line	:
City	:	ROCK FALLS
State	:	IL
Zip	:	61071-1416
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1306 GARFIELD ST
Second Line	:
City	:	ROCK FALLS
State	:	IL
Zip	:	61071-1416
Country	:	US
Telephone Number	:	815-906-4564
Fax Number	:

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

Provider Enumeration Date	:	04/17/2025
Last Update Date	:	04/17/2025

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Directions to “ VIOLET HAVENAR ” Practice Location

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