Healthcare Provider Details

I. General information

NPI: 1720437627
Provider Name (Legal Business Name): LINDA HAVARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

996 NW CIRCLE BLVD STE 103
CORVALLIS OR
97330-1485
US

IV. Provider business mailing address

996 NW CIRCLE BLVD STE 103
CORVALLIS OR
97330-1485
US

V. Phone/Fax

Practice location:
  • Phone: 541-768-4370
  • Fax:
Mailing address:
  • Phone: 541-768-4370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: