Individual
MRS. STEPHANIE A HAVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2401 W UNIVERSITY AVE, MUNCIE, IN 47303-3428
(765) 741-1515
Mailing address
1200 W WHITE RIVER BLVD, RCS PROVIDER ENROLLMENT, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
28159230A
IN
363LA2200X
Adult Health Nurse Practitioner
Primary
71004577A
IN
Other
Enumeration date
08/22/2013
Last updated
01/13/2021
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