Provider Demographics
NPI:1730621913
Name:HAVENER, KATHERINE (IBCLC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:HAVENER
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7922 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-1847
Mailing Address - Country:US
Mailing Address - Phone:540-926-4111
Mailing Address - Fax:
Practice Address - Street 1:7922 SEQUOIA DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-1847
Practice Address - Country:US
Practice Address - Phone:540-926-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAL-99575174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN