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General NPI Number Information
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NPI Number | 1669318093
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Entity Type | Organization
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Legal Business Name | JADE HAVEN LLC
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Dates
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Enumeration Date | 04/27/2026
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Last Update Date | 04/27/2026
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Provider Practice Location Address
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Address Line | 7912 WHISTLE CREEK CT
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City | BYRON CENTER
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State | MI
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Zip | 49315-9185
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Country | US
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Telephone | 616-212-0081
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Fax |
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Provider Business Mailing Address
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Address Line | 7912 WHISTLE CREEK CT
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City | BYRON CENTER
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State | MI
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Zip | 49315-9185
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Country | US
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Telephone | 616-212-0081
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | CHRISTINA WANG
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Credential | PA-C
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Telephone | 616-212-0081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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