Provider Demographics
NPI:1821568965
Name:CARRIVEAU, JUANITA ANN
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:ANN
Last Name:CARRIVEAU
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 1:1181 S 41ST ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-6522
Mailing Address - Country:US
Mailing Address - Phone:541-914-1218
Mailing Address - Fax:
Practice Address - Street 1:1181 S 41ST ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-6522
Practice Address - Country:US
Practice Address - Phone:541-914-1218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-02
Last Update Date:2018-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR085074553RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse