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Individual
SARAH MCKENDRICK HAVENS
Active
Individual
SARAH MCKENDRICK HAVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601005040
MI
363AM0700X
Medical Physician Assistant
5601005040
MI
363AS0400X
Surgical Physician Assistant
5601005040
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20-5501357-0
BCBS PIN
MI
01
—
200E011770
BCBS GROUP NUMBER
MI
01
—
5601005040
MICHIGAN LICENSE
MI
Enumeration date
09/04/2007
Last updated
09/03/2010
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