Individual
MARILYN GRISHAM BIVENS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
104 CONTEMPO AVE, WEST MONROE, LA 71291-5312
(318) 329-8181
(318) 329-8183
Mailing address
104 CONTEMPO AVE, WEST MONROE, LA 71291-5312
(318) 329-8181
(318) 329-8183
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
12125R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12125R
MEDICAL LICENSE
LA
05
—
1695611
—
LA
Enumeration date
12/13/2005
Last updated
03/07/2023
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