Healthcare Provider Details

I. General information

NPI: 1861510976
Provider Name (Legal Business Name): PAMELA S. HAVERLY R.N.,B.S.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8127 TANAGER CT
INDIANAPOLIS IN
46256-1775
US

IV. Provider business mailing address

8127 TANAGER COURT
INDIANAPOLIS IN
46256-1775
US

V. Phone/Fax

Practice location:
  • Phone: 317-594-8614
  • Fax:
Mailing address:
  • Phone: 317-594-8614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number28094896A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: