Individual
MR. GREGORY KENT JIVIDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
20370 POE SHOLES DR, BEND, OR 97703-7938
(541) 318-1377
(541) 330-6455
Mailing address
20370 POE SHOLES DR, BEND, OR 97703-7938
(541) 318-1377
(541) 330-6455
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
201505879RN
OR
Other
Enumeration date
07/28/2018
Last updated
07/28/2018
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