Healthcare Provider Details

I. General information

NPI: 1760972228
Provider Name (Legal Business Name): COURTNEY HAVEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 S POTOMAC ST STE 300
AURORA CO
80012-4510
US

IV. Provider business mailing address

1444 S POTOMAC ST STE 300
AURORA CO
80012-4510
US

V. Phone/Fax

Practice location:
  • Phone: 303-750-0822
  • Fax: 303-750-1298
Mailing address:
  • Phone: 303-750-0822
  • Fax: 303-750-1298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0005265
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: