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General NPI Number Information
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NPI Number | 1710510045
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Entity Type | Organization
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Legal Business Name | HAVENER VENTURES LLC
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Dates
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Enumeration Date | 02/14/2020
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Last Update Date | 01/10/2023
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Provider Practice Location Address
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Address Line | 2311 SANFORD AVE SW
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City | ROANOKE
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State | VA
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Zip | 24014-1122
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Country | US
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Telephone | 540-253-1984
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Fax | 540-566-5035
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Provider Business Mailing Address
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Address Line | 7922 SEQUOIA DR
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City | ROANOKE
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State | VA
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Zip | 24019-1847
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Country | US
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Telephone | 540-926-4111
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHERINE HAVENER
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Credential | IBCLC RLC
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Telephone | 540-926-4111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number |
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License Number State |
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