Provider Demographics
NPI:1447861273
Name:BIVONE, NICOLE (AUD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BIVONE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 OLD CHAIN BRIDGE RD STE 185
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3945
Mailing Address - Country:US
Mailing Address - Phone:703-942-8110
Mailing Address - Fax:703-942-8042
Practice Address - Street 1:1320 OLD CHAIN BRIDGE RD STE 185
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3945
Practice Address - Country:US
Practice Address - Phone:703-942-8110
Practice Address - Fax:703-942-8042
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002972231H00000X
VA2101002697237600000X
VA2201001870231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter