Provider Demographics
NPI:1548306459
Name:HAVEN, SHILOH M (NP)
Entity type:Individual
Prefix:
First Name:SHILOH
Middle Name:M
Last Name:HAVEN
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:105 CORPORATE DRIVE
Mailing Address - Street 2:NRHN REHAB PHYSICIAN SERVICES
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801
Mailing Address - Country:US
Mailing Address - Phone:603-501-5547
Mailing Address - Fax:603-501-5650
Practice Address - Street 1:70 BUTLER STREET
Practice Address - Street 2:NRHN REHAB PHYSICIAN SERVICES
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079
Practice Address - Country:US
Practice Address - Phone:603-501-5547
Practice Address - Fax:603-501-5650
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2020-03-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA262793363LA2200X
NH080161-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP9574OtherBCBS
MA0712116Medicaid
NH3118601Medicaid