Provider Demographics
NPI:1619913100
Name:HAVERS, COURTENAY NICOLE (MD)
Entity type:Individual
Prefix:
First Name:COURTENAY
Middle Name:NICOLE
Last Name:HAVERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9621 RIDGETOP BLVD NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8502
Mailing Address - Country:US
Mailing Address - Phone:360-782-3400
Mailing Address - Fax:360-782-3450
Practice Address - Street 1:9621 RIDGETOP BLVD NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8502
Practice Address - Country:US
Practice Address - Phone:360-782-3400
Practice Address - Fax:360-782-3450
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041968207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA169190OtherLABOR AND INDUSTRIES
WA1014702Medicaid
WA8359416Medicaid
8918BROtherREGENCE BLUESHIELD
P00023573OtherRAILROAD MEDICARE
7405427OtherAETNA
WA169190OtherLABOR AND INDUSTRIES
WAGAB36811Medicare PIN
WAG8856728Medicare PIN
WAG8852219Medicare PIN
P00023573OtherRAILROAD MEDICARE
WAG8855432Medicare PIN
WAG8851423Medicare PIN
H81779Medicare UPIN