Provider Demographics
NPI:1326886235
Name:SHIVENER, CARL HENRY JR
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:HENRY
Last Name:SHIVENER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3747 PAXTON AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-2332
Mailing Address - Country:US
Mailing Address - Phone:513-328-6739
Mailing Address - Fax:
Practice Address - Street 1:3747 PAXTON AVE APT 1
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-2332
Practice Address - Country:US
Practice Address - Phone:513-328-6739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty