Healthcare Provider Details

I. General information

NPI: 1851084297
Provider Name (Legal Business Name): DAKOTA BIVENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5180 GENERAL SQUIER RD
DRYDEN MI
48428-9218
US

IV. Provider business mailing address

5180 GENERAL SQUIER RD
DRYDEN MI
48428-9218
US

V. Phone/Fax

Practice location:
  • Phone: 248-202-4185
  • Fax:
Mailing address:
  • Phone: 248-202-4185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704341877
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: