Provider Demographics
NPI:1316492416
Name:SPIVEY, DANA M (NP)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:M
Last Name:SPIVEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:M
Other - Last Name:FIEDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 3407
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47733-3407
Mailing Address - Country:US
Mailing Address - Phone:812-450-7720
Mailing Address - Fax:812-450-7730
Practice Address - Street 1:519 HARRIET ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1715
Practice Address - Country:US
Practice Address - Phone:812-450-7720
Practice Address - Fax:812-450-7730
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006681A363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100441050Medicaid
IN201400170Medicaid