Provider Demographics
NPI:1730769266
Name:HAVENS, CHERYL DAWN (RDN)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:DAWN
Last Name:HAVENS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7114 SW BOUCHAINE ST
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-8856
Mailing Address - Country:US
Mailing Address - Phone:503-705-1610
Mailing Address - Fax:
Practice Address - Street 1:7114 SW BOUCHAINE ST
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-8856
Practice Address - Country:US
Practice Address - Phone:503-705-1610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D10281170133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered