| Doctor Name: | STACEY RENEE HAVEMAN |
| NPI Number: | 1023309796 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHYSICIAN ASSISTANT |
| License Number: | PA60389054 |
| Business Practice Address: | 55 W Tietan St Walla Walla, WA - 993624445 |
| Business Phone Number: | 5095253720 |
| Business Fax Number: | 5095221592 |
| Mailing Address: | 55 W Tietan St, WALLA WALLA |
| State: | WA |
| Postal Code: | 993624445 |
| Phone Number: | 5095253720 |
| Fax Number: | 5095221592 |
| NPI Enumeration Date: | 04/28/2011 |
| NPI Last Update Date: | 01/18/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA60389054 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |