Provider Demographics
NPI:1003779380
Name:JIVERS, VANESSA (RN)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:
Last Name:JIVERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ANCHOR CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7327
Mailing Address - Country:US
Mailing Address - Phone:839-223-0831
Mailing Address - Fax:
Practice Address - Street 1:919 TRUE ST STE H
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1662
Practice Address - Country:US
Practice Address - Phone:839-223-0831
Practice Address - Fax:803-233-4239
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-04
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC008729661246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory