Provider Demographics
NPI:1316098437
Name:TIVE, ANN ELEANOR (LM)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:ELEANOR
Last Name:TIVE
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2429 ELM ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2729
Mailing Address - Country:US
Mailing Address - Phone:360-734-2182
Mailing Address - Fax:360-752-2498
Practice Address - Street 1:2429 ELM ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2729
Practice Address - Country:US
Practice Address - Phone:360-734-2182
Practice Address - Fax:360-752-2498
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7095706Medicaid