Provider Demographics
NPI:1003265299
Name:RIVERA, ANNE CHRISTINE (RD)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:CHRISTINE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 1ST ST
Mailing Address - Street 2:49MDG/SGPZ
Mailing Address - City:HOLLOMAN AFB
Mailing Address - State:NM
Mailing Address - Zip Code:88330-8273
Mailing Address - Country:US
Mailing Address - Phone:575-572-6047
Mailing Address - Fax:575-572-2259
Practice Address - Street 1:280 1ST ST
Practice Address - Street 2:49MDG/SGPZ
Practice Address - City:HOLLOMAN AFB
Practice Address - State:NM
Practice Address - Zip Code:88330-8273
Practice Address - Country:US
Practice Address - Phone:575-572-6047
Practice Address - Fax:575-572-2259
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered