MEDICARE: SAFE HAVIN ANESTHESIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	AP30007512	WA

General Provider Information

NPI Number	:	1114340098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFE HAVIN ANESTHESIA

Provider Business Mailing Address
First Line	:	6404 S LATAH HILLS CT
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99224-8530
Country	:	US
Telephone Number	:	509-481-0487
Fax Number	:	509-228-9542

Provider Business Practice Location Address
First Line	:	6404 S LATAH HILLS CT
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99224-8530
Country	:	US
Telephone Number	:	509-481-0487
Fax Number	:	509-228-9542

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. JENNIFER SUE HAVIN
Credential	:	CRNA
Telephone Number	:	509-481-0487

Provider Enumeration Date	:	01/28/2014
Last Update Date	:	01/28/2014

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