Individual
RYAN HAVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGPCNP-BC
Contact information
Practice address
3601 W 13 MILE RD, ROYAL OAK, MI 48073-6712
(248) 898-4021
(248) 898-1473
Mailing address
26901 BEAUMONT BLVD STE 3D, SOUTHFIELD, MI 48033-3849
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4704230300
MI
363LG0600X
Gerontology Nurse Practitioner
Primary
4704230300
MI
363LP2300X
Primary Care Nurse Practitioner
4704230300
MI
Other
Enumeration date
10/27/2014
Last updated
11/04/2021
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