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General NPI Number Information
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NPI Number | 1487559548
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Entity Type | Organization
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Legal Business Name | THE HAVEN PRIMARY CARE
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Dates
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Enumeration Date | 10/09/2026
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Last Update Date | 10/09/2026
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Provider Practice Location Address
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Address Line | 202 6TH ST
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City | GROTTOES
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State | VA
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Zip | 24441-1701
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Country | US
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Telephone | 540-480-4613
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Fax |
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Provider Business Mailing Address
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Address Line | 202 6TH ST
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City | GROTTOES
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State | VA
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Zip | 24441-1701
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/PROVIDER
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Name | MANDEE STULL
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Credential | NP
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Telephone | 540-480-4613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State | NULL
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