Individual
ELIZABETH A DEHAVEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
101 KINGSBURY BLVD, FREDERICKTOWN, MO 63645-7959
(573) 561-1555
(573) 783-5951
Mailing address
101 KINGSBURY BLVD, FREDERICKTOWN, MO 63645-7959
(573) 561-1555
(573) 783-5951
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2015021530
MO
Other
Enumeration date
07/15/2015
Last updated
04/04/2019
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