Healthcare Provider Details

I. General information

NPI: 1376158311
Provider Name (Legal Business Name): HAVEN STEVENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 N MONROE ST.
MONROE MI
48162
US

IV. Provider business mailing address

1052 N MONROE ST
MONROE MI
48162
US

V. Phone/Fax

Practice location:
  • Phone: 734-242-9550
  • Fax: 734-971-2303
Mailing address:
  • Phone: 734-242-9550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704329812
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: