Provider Demographics
NPI:1730152620
Name:MCIVER, MARIANNE (CNS, BC)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:MCIVER
Suffix:
Gender:F
Credentials:CNS, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 E RALEIGH ST
Mailing Address - Street 2:
Mailing Address - City:SILER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27344-3416
Mailing Address - Country:US
Mailing Address - Phone:919-663-1137
Mailing Address - Fax:
Practice Address - Street 1:234 E RALEIGH ST
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344-3416
Practice Address - Country:US
Practice Address - Phone:919-663-1137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN 2342364SP0809X
NC101752364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP56343Medicare UPIN