Individual
LILLY MAY HAVENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1000 CARONDELET DR STE 201B, KANSAS CITY, MO 64114-4673
(913) 956-2250
(913) 956-2251
Mailing address
201 NW R.D. MIZE RD, PROVIDER ENROLLMENT SUITE 210, BLUE SPRINGS, MO 64014
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
83-80260-101
KS
Other
Enumeration date
07/06/2021
Last updated
09/03/2021
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