Healthcare Provider Details

I. General information

NPI: 1447616438
Provider Name (Legal Business Name): CARRIE JIVIDEN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 W FAIR AVE UNIT 113
LANCASTER OH
43130-8820
US

IV. Provider business mailing address

2151 W FAIR AVE UNIT 113
LANCASTER OH
43130-8820
US

V. Phone/Fax

Practice location:
  • Phone: 740-475-8446
  • Fax:
Mailing address:
  • Phone: 740-475-8446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: