Provider Demographics
NPI:1275687287
Name:BLIVEN, ADA (APN)
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:
Last Name:BLIVEN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 HOLLANDER ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08882-1102
Mailing Address - Country:US
Mailing Address - Phone:732-238-2492
Mailing Address - Fax:732-235-8149
Practice Address - Street 1:125 PATERSON ST
Practice Address - Street 2:SUITE # 6129
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1962
Practice Address - Country:US
Practice Address - Phone:732-235-7005
Practice Address - Fax:732-235-8149
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00115400363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care