Basic Information
| Provider Information | |||||||||
| NPI: | 1265938807 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAVENS | ||||||||
| FirstName: | SHANNON | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8617 CASLER CIR | ||||||||
| Address2: | |||||||||
| City: | TEMPLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765025242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2542171604 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13915 BURNET RD | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787286517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035321400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2018 | ||||||||
| LastUpdateDate: | 04/03/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 172506 | TX | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.