| NPI | 1174906754 |
|---|---|
| Former Name | EMILY J HAVENER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0004297) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2015-0033) |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2017-12-12 |