Individual
JACKIE B MICHAEL-HAVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
500 5TH ST, BROOKINGS, OR 97415-9702
(541) 412-2000
(541) 412-2081
Mailing address
500 5TH ST, BROOKINGS, OR 97415-9702
(541) 412-2000
(541) 412-2081
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
202000081-NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1083656367
CURRY MEDICAL CENTER NPI
OR
01
—
1487696985
CURRY GENERAL HOSPITAL NPI
OR
05
—
500776554
—
OR
Enumeration date
03/09/2017
Last updated
09/03/2020
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