Healthcare Provider Details

I. General information

NPI: 1215361209
Provider Name (Legal Business Name): HEATHER L BIVENS CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER L GREENBERG

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 LA JOLLA VILLAGE DR
SAN DIEGO CA
92161-0002
US

IV. Provider business mailing address

12741 LAUREL ST UNIT 88
LAKESIDE CA
92040-2138
US

V. Phone/Fax

Practice location:
  • Phone: 858-552-8585
  • Fax:
Mailing address:
  • Phone: 619-252-5658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number4023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: