Individual
TAMMY M JIVIDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-5201
(336) 716-2255
(336) 716-3202
Mailing address
117 E KINGS HIGHWAY, EDEN, NC 27288-5201
(336) 623-9711
(336) 623-9711
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
0024168039
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
1232
NC
Other
Enumeration date
10/28/2008
Last updated
10/27/2022
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