Provider Demographics
NPI:1356929038
Name:JIVIDEN, ISABELLA ROSE
Entity type:Individual
Prefix:MISS
First Name:ISABELLA
Middle Name:ROSE
Last Name:JIVIDEN
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 1:990 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-2076
Mailing Address - Country:US
Mailing Address - Phone:330-524-1156
Mailing Address - Fax:
Practice Address - Street 1:990 FIELDSTONE DR
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-2076
Practice Address - Country:US
Practice Address - Phone:330-524-1156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker