Individual
MRS. HAVILAH NOEL BRODHEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N., MSN, FNP-BC
Contact information
Practice address
2275 NE DOCTORS DR, STE 1, BEND, OR 97701-6324
(541) 316-5693
(844) 395-8842
Mailing address
2947 NE YELLOW RIBBON DR, BEND, OR 97701-7657
(970) 275-6108
(412) 550-9475
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
201500894NP-PP
OR
363LP2300X
Primary Care Nurse Practitioner
Primary
201407546NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500678393
—
OR
Enumeration date
06/07/2011
Last updated
08/15/2019
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