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NPI Code Detail

MEDICARE: ELIZABETH MARY HAVILAND NURSE PRACTITIONER

MEDICARE: ELIZABETH MARY HAVILAND NURSE PRACTITIONER
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN002307NV

General Provider Information

NPI Number : 1902946312
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH MARY HAVILAND NURSE PRACTITIONER
Provider Business Mailing Address
First Line : 28801 BEAR VALLEY RD # B
Second Line :
City : TEHACHAPI
State : CA
Zip : 93561-7495
Country : US
Telephone Number : 702-781-4988
Fax Number :
Provider Business Practice Location Address
First Line : 1050 E FLAMINGO RD STE 107
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-7429
Country : US
Telephone Number : 702-781-4988
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2007
Last Update Date : 09/30/2024

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Directions to “ ELIZABETH MARY HAVILAND NURSE PRACTITIONER” Practice Location

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