Provider Demographics
NPI:1427490770
Name:HAVER, JULIE DARLENE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:DARLENE
Last Name:HAVER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6551 CENTERVILLE BUSINESS PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2696
Mailing Address - Country:US
Mailing Address - Phone:937-291-6830
Mailing Address - Fax:937-291-6893
Practice Address - Street 1:6551 CENTERVILLE BUSINESS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-2696
Practice Address - Country:US
Practice Address - Phone:937-291-6830
Practice Address - Fax:937-291-6893
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA14855363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000828354OtherBCBS OHIO
OH0088148Medicaid
OH000000828354OtherBCBS OHIO