Provider Demographics
NPI:1386936409
Name:NIVENS, PAIGE
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:NIVENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 MATTHEWS TOWNSHIP PKWY
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-4659
Mailing Address - Country:US
Mailing Address - Phone:704-844-6822
Mailing Address - Fax:704-246-2139
Practice Address - Street 1:1811 MATTHEWS TOWNSHIP PKWY
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-4659
Practice Address - Country:US
Practice Address - Phone:704-844-6822
Practice Address - Fax:704-246-2139
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-08
Last Update Date:2011-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13764183500000X
SC12824183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist