Provider Demographics
NPI:1174955538
Name:BLIVEN, CHERYL A (NP)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:A
Last Name:BLIVEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 WIND RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4149
Mailing Address - Country:US
Mailing Address - Phone:715-847-2812
Mailing Address - Fax:715-847-2619
Practice Address - Street 1:425 WIND RIDGE DR
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4149
Practice Address - Country:US
Practice Address - Phone:715-847-2812
Practice Address - Fax:715-847-2619
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5375363L00000X, 363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner