Provider Demographics
NPI:1003261074
Name:NIVENS, DOROTHY (NP)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:NIVENS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4363 TUCKER CHASE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28107-7812
Mailing Address - Country:US
Mailing Address - Phone:704-322-9156
Mailing Address - Fax:
Practice Address - Street 1:4363 TUCKER CHASE DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:NC
Practice Address - Zip Code:28107-7812
Practice Address - Country:US
Practice Address - Phone:704-322-9156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-27
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008528363LF0000X
SC25235363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily