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Individual

JENNIFER ELIZABETH BIVENS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
4940 EASTERN AVE, BALTIMORE, MD 21224-2735
(410) 550-0395
Mailing address
4940 EASTERN AVE, BALTIMORE, MD 21224-2735
(410) 550-0395

Taxonomy

Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
50.0055794RX
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1152951
NCCPA
PA
Enumeration date
04/02/2019
Last updated
08/26/2020
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