Individual
DEWAYNE CARL HAVERSTICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NREMTP
Contact information
Practice address
453 SOUTH NOVACEL DR, FORT RUCKER, AL 36362
(251) 518-9110
Mailing address
104 S SPRINGVIEW DR, ENTERPRISE, AL 36330-5060
(251) 518-9110
Taxonomy
Speciality
Code
Description
License number
State
146L00000X
Paramedic
Primary
0800200
AL
Other
Enumeration date
08/07/2012
Last updated
08/07/2012
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