Provider Demographics
NPI:1447616438
Name:JIVIDEN, CARRIE (CNM)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:JIVIDEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 W FAIR AVE
Mailing Address - Street 2:UNIT 113
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8820
Mailing Address - Country:US
Mailing Address - Phone:740-475-8446
Mailing Address - Fax:
Practice Address - Street 1:2151 W FAIR AVE
Practice Address - Street 2:UNIT 113
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8820
Practice Address - Country:US
Practice Address - Phone:740-475-8446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife