Provider Demographics
NPI:1174964597
Name:BIVINS, SANETTA (LPN)
Entity type:Individual
Prefix:
First Name:SANETTA
Middle Name:
Last Name:BIVINS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17320 GLENDALE AVE
Mailing Address - Street 2:NONE
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-1619
Mailing Address - Country:US
Mailing Address - Phone:216-965-0598
Mailing Address - Fax:
Practice Address - Street 1:17320 GLENDALE AVE
Practice Address - Street 2:NONE
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-1619
Practice Address - Country:US
Practice Address - Phone:216-965-0598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-14
Last Update Date:2013-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH125959164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse