Provider Demographics
NPI:1528313012
Name:HAVERTY, SARA M (CRNA)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:M
Last Name:HAVERTY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:M
Other - Last Name:MATHESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:67721 ROBIN ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43718
Mailing Address - Country:US
Mailing Address - Phone:614-657-4065
Mailing Address - Fax:
Practice Address - Street 1:2951 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701
Practice Address - Country:US
Practice Address - Phone:740-454-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH312504163WC0200X
OH13843367500000X
OHAPRN.CRNA.13843367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine