Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 5008528 | NC |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 25235 | SC |
NPI | 1003261074 |
---|---|
Provider Name | Dorothy Nivens |
First Address | Huntersville, NC 28078-9120 |
Second Address | Huntersville, NC 28078-9120 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2016 |
Last Update Date | 12/11/2021 |