Individual
JENNIFER E DEHAVEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1900 ELECTRIC RD, SALEM, VA 24153-7474
(540) 776-4100
Mailing address
PO BOX 13888, ROANOKE, VA 24038-3888
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001218765
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
0024170649
VA
Other
Enumeration date
01/29/2013
Last updated
03/05/2013
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