Basic Information
| Provider Information | |||||||||
| NPI: | 1427490770 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAVER | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | DARLENE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6551 CENTERVILLE BUSINESS PKWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454592696 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372916830 | ||||||||
| FaxNumber: | 9372916893 | ||||||||
| Practice Location | |||||||||
| Address1: | 6551 CENTERVILLE BUSINESS PKWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454592696 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372916830 | ||||||||
| FaxNumber: | 9372916893 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2013 | ||||||||
| LastUpdateDate: | 09/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 09/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | COA14855 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 000000828354 | 01 | OH | BCBS OHIO | OTHER | 0088148 | 05 | OH | MEDICAID |