Healthcare Provider Details

I. General information

NPI: 1699633578
Provider Name (Legal Business Name): HAVEN WOMEN'S CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 03/15/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2741 W FOND DU LAC AVE
MILWAUKEE WI
53210-2624
US

IV. Provider business mailing address

PO BOX 401477
LAS VEGAS NV
89140-1477
US

V. Phone/Fax

Practice location:
  • Phone: 414-867-3553
  • Fax: 414-867-3633
Mailing address:
  • Phone: 888-683-2584
  • Fax: 888-683-2567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name: KANDYACE MORRIS
Title or Position: CEO
Credential:
Phone: 702-830-5325