Provider Demographics
NPI:1316352669
Name:TIVIS, CORRIE (RN)
Entity type:Individual
Prefix:
First Name:CORRIE
Middle Name:
Last Name:TIVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 N 11TH ST APT 5
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-1916
Mailing Address - Country:US
Mailing Address - Phone:701-206-0414
Mailing Address - Fax:
Practice Address - Street 1:1929 N 11TH ST APT 5
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-1916
Practice Address - Country:US
Practice Address - Phone:701-206-0414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR31795251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care