Provider Demographics
NPI:1730789306
Name:HIVELY, JUDY
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:HIVELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16412 51ST ST SE
Mailing Address - Street 2:
Mailing Address - City:KINDRED
Mailing Address - State:ND
Mailing Address - Zip Code:58051-9641
Mailing Address - Country:US
Mailing Address - Phone:701-361-4875
Mailing Address - Fax:
Practice Address - Street 1:16412 51ST ST SE
Practice Address - Street 2:
Practice Address - City:KINDRED
Practice Address - State:ND
Practice Address - Zip Code:58051-9641
Practice Address - Country:US
Practice Address - Phone:701-361-4875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant