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General NPI Number Information
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NPI Number | 1336197417
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Entity Type | Individual
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Provider Name | WILLIAM HAVENS JR. CRNA
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Gender | Male
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 09/20/2016
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Provider Practice Location Address
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Address Line | 505 S JOHN REDDITT DR
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City | LUFKIN
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State | TX
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Zip | 75904-3120
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Country | US
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Telephone | 936-639-3036
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Fax | 936-639-3064
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Provider Business Mailing Address
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Address Line | 160 SANDALWOOD ST
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City | LUFKIN
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State | TX
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Zip | 75904-0449
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Country | US
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Telephone | 936-639-3036
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Fax | 936-639-3064
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 254777
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License Number State | TX
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