Provider Demographics
NPI:1295377414
Name:JAIVER, CHARMAINE ABIGAN
Entity Type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:ABIGAN
Last Name:JAIVER
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 1:7345 WOODLAND DR STE E
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-1737
Mailing Address - Country:US
Mailing Address - Phone:317-268-8525
Mailing Address - Fax:317-268-8526
Practice Address - Street 1:4441 BONNEVILLE CIR
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2887
Practice Address - Country:US
Practice Address - Phone:510-674-3858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY41696163W00000X
NY79537163W00000X
NMRN-87864163W00000X
CA95237917163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse