| Organization Name: | HAVENS FAMILY CLINIC |
| NPI Number: | 1134249964 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PATRICIA LYNN HEAD (NURSE PRACTIONER) |
| Mailing Address: | 109 Latigo Ln Suite C Canon City |
| State: | CO US |
| Postal Code: | 812128112 |
| Phone Number: | 7192763211 |
| Fax Number: | 7192763011 |
| NPI Enumeration Date: | 03/29/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 98310 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |