Provider Demographics
NPI:1992930077
Name:HAFEN, KENDRA EILEEN
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:EILEEN
Last Name:HAFEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S 100 E
Mailing Address - Street 2:SUITE 11
Mailing Address - City:KANAB
Mailing Address - State:UT
Mailing Address - Zip Code:84741-3632
Mailing Address - Country:US
Mailing Address - Phone:435-644-4520
Mailing Address - Fax:435-644-4524
Practice Address - Street 1:310 S 100 E
Practice Address - Street 2:SUITE 11
Practice Address - City:KANAB
Practice Address - State:UT
Practice Address - Zip Code:84741-3632
Practice Address - Country:US
Practice Address - Phone:435-644-4520
Practice Address - Fax:435-644-4524
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other