Provider Demographics
NPI:1902946312
Name:HAVILAND, ELIZABETH MARY (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARY
Last Name:HAVILAND
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:28801 BEAR VALLEY RD # B
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-7495
Mailing Address - Country:US
Mailing Address - Phone:702-781-4988
Mailing Address - Fax:
Practice Address - Street 1:1050 E FLAMINGO RD STE 107
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7429
Practice Address - Country:US
Practice Address - Phone:702-781-4988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002307363LP0808X
VT101.0097520363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health