Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | COA12011-NP | OH |
NPI | 1043500143 |
---|---|
Provider Name | Brooke N. Haven |
First Address | Dayton, OH 45475-1084 |
Second Address | Dayton, OH 45404-1898 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2011 |
Last Update Date | 11/09/2015 |