Provider Demographics
NPI:1437149747
Name:BIVENS, MARGARETE LATRICE (PA)
Entity Type:Individual
Prefix:
First Name:MARGARETE
Middle Name:LATRICE
Last Name:BIVENS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N IH 35 STE 320
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1926
Mailing Address - Country:US
Mailing Address - Phone:512-324-8320
Mailing Address - Fax:512-324-8326
Practice Address - Street 1:1400 N IH 35 STE 320
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1926
Practice Address - Country:US
Practice Address - Phone:512-324-8320
Practice Address - Fax:512-324-8326
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02958363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N6004OtherBCBS
TX180307401Medicaid
TX8B6039Medicare PIN
TX180307401Medicaid