| NPI | 1679017552 |
|---|---|
| Doing Business As | HAVENS MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | SHELLEY GAST VP Managed Care 502-559-9409 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 28168470A) |
| Enumeration Date | 2016-12-12 |
| Last Update Date | 2023-11-07 |