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NPI Code Detail

MEDICARE: HAVEN ELISE BYRNE

MEDICARE: HAVEN ELISE BYRNE
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1942098397
Entity Type Code : Individual
Provider Name (Legal Business Name) : HAVEN ELISE BYRNE
Provider Business Mailing Address
First Line : 602 E HOUSTON DR
Second Line :
City : BROKEN ARROW
State : OK
Zip : 74012-4321
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2029 S SHERIDAN RD
Second Line :
City : TULSA
State : OK
Zip : 74112-7309
Country : US
Telephone Number : 918-587-9471
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2025
Last Update Date : 04/28/2025

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