Provider Demographics
NPI:1740596923
Name:BIVINS, DAWNA MARIA (MAED)
Entity Type:Individual
Prefix:
First Name:DAWNA
Middle Name:MARIA
Last Name:BIVINS
Suffix:
Gender:F
Credentials:MAED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COURTHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-1715
Mailing Address - Country:US
Mailing Address - Phone:510-693-7711
Mailing Address - Fax:
Practice Address - Street 1:2 COURTHOUSE LN
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1715
Practice Address - Country:US
Practice Address - Phone:510-693-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16594009802390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program