Healthcare Provider Details

I. General information

NPI: 1447328596
Provider Name (Legal Business Name): SUZANNE L. HAVEMAN, CRNFA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 MAYWOOD WAY
ASHLAND OR
97520-9511
US

IV. Provider business mailing address

245 MAYWOOD WAY
ASHLAND OR
97520-9511
US

V. Phone/Fax

Practice location:
  • Phone: 541-488-1840
  • Fax: 541-482-7642
Mailing address:
  • Phone: 541-488-1840
  • Fax: 541-482-7642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number566627
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number
License Number StateOR

VIII. Authorized Official

Name: MRS. SUZANNE L. HAVEMAN
Title or Position: PRESIDENT
Credential: CRNFA
Phone: 541-488-1840