Provider Demographics
NPI:1003439324
Name:RIVES, BLAIR CAROLINE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:BLAIR
Middle Name:CAROLINE
Last Name:RIVES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 CHARLESTON PL
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24083-3126
Mailing Address - Country:US
Mailing Address - Phone:540-353-2760
Mailing Address - Fax:
Practice Address - Street 1:150 MARKET RIDGE LN
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24083-3258
Practice Address - Country:US
Practice Address - Phone:540-966-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179497363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily