Healthcare Provider Details

I. General information

NPI: 1154544716
Provider Name (Legal Business Name): YVONNE ELALNE BIVINS RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 OLIVER ST
NEWARK NJ
07105-2507
US

IV. Provider business mailing address

701 MCCANDLESS PL
LINDEN NJ
07036-1234
US

V. Phone/Fax

Practice location:
  • Phone: 973-466-1300
  • Fax: 973-466-2715
Mailing address:
  • Phone: 908-587-0589
  • Fax: 973-466-2715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number26NO10876200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: