Provider Demographics
NPI:1184619348
Name:NIVEN, BARBARA BETH (PAC)
Entity type:Individual
Prefix:MISS
First Name:BARBARA
Middle Name:BETH
Last Name:NIVEN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 N TEJON STREET
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6231
Mailing Address - Country:US
Mailing Address - Phone:719-473-0872
Mailing Address - Fax:719-630-3658
Practice Address - Street 1:2709 N TEJON ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6231
Practice Address - Country:US
Practice Address - Phone:719-473-0872
Practice Address - Fax:719-630-3658
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO304363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P30175Medicare ID - Type Unspecified