Individual
MRS. AUDREY HAVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
125 E BROAD ST, ELYRIA, OH 44035-6400
(440) 406-5500
Mailing address
3417 W 148TH ST, CLEVELAND, OH 44111-2119
(330) 241-3202
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
50.005775RX
OH
Other
Enumeration date
01/17/2019
Last updated
12/06/2023
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