Provider Demographics
NPI:1629391594
Name:BIVENS, ANGELA M (MSN, NP-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:BIVENS
Suffix:
Gender:F
Credentials:MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 RIVER VUE AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-4717
Mailing Address - Country:US
Mailing Address - Phone:704-650-7459
Mailing Address - Fax:704-733-4917
Practice Address - Street 1:69 RIVER VUE AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02889-4717
Practice Address - Country:US
Practice Address - Phone:704-650-7459
Practice Address - Fax:704-733-4917
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP37303363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily