Healthcare Provider Details

I. General information

NPI: 1114340098
Provider Name (Legal Business Name): SAFE HAVIN ANESTHESIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2014
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6404 S LATAH HILLS CT
SPOKANE WA
99224-8530
US

IV. Provider business mailing address

6404 S LATAH HILLS CT
SPOKANE WA
99224-8530
US

V. Phone/Fax

Practice location:
  • Phone: 509-481-0487
  • Fax: 509-228-9542
Mailing address:
  • Phone: 509-481-0487
  • Fax: 509-228-9542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP30007512
License Number StateWA

VIII. Authorized Official

Name: MS. JENNIFER SUE HAVIN
Title or Position: PRESIDENT
Credential: CRNA
Phone: 509-481-0487