Active NPI
Eren Havrilak
- Athletic Trainer
- Nampa, ID
National Provider Identifier
1821484809
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT - 507
- Practice address
- 218 S Blue Heron Way
Nampa, ID 83687-8985 - Phone
- (847) 560-0811
- NPI assigned
- Apr 7, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT - 507 | ID | Primary |
Addresses
Primary practice location
218 S Blue Heron Way
Nampa, ID 83687-8985
Mailing address
218 S Blue Heron Way
Nampa, ID 83687-8985
Phone (847) 560-0811
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT - 507 | ID | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1428364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428364800000",
"number": "1821484809",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "218 S BLUE HERON WAY",
"city": "NAMPA",
"state": "ID",
"postal_code": "836878985",
"telephone_number": "847-560-0811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "218 S BLUE HERON WAY",
"city": "NAMPA",
"state": "ID",
"postal_code": "836878985",
"telephone_number": "847-560-0811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAVRILAK",
"first_name": "EREN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-04-07",
"last_updated": "2015-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "ID",
"license": "AT - 507",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nampa, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.