Provider Demographics
NPI:1164819561
Name:BIVINS, JUDY
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:BIVINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10515 HAYES RD
Mailing Address - Street 2:
Mailing Address - City:CLARKLAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49234-9748
Mailing Address - Country:US
Mailing Address - Phone:517-592-3038
Mailing Address - Fax:
Practice Address - Street 1:10515 HAYES RD
Practice Address - Street 2:
Practice Address - City:CLARKLAKE
Practice Address - State:MI
Practice Address - Zip Code:49234-9748
Practice Address - Country:US
Practice Address - Phone:517-592-3038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703054205164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse