Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 01065231A | IN |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 01065231A | IN |
NPI | 1043420078 |
---|---|
Provider Name | Dr. Jennifer Lynn Havener |
First Address | Indianapolis, IN 46250-2890 |
Second Address | Greenwood, IN 46143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 10/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200913440 | (05) | IN |