Provider Demographics
NPI:1073838942
Name:RIVET, SARA ANN (LMT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ANN
Last Name:RIVET
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 COORS BYP NW
Mailing Address - Street 2:APT 515
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4024
Mailing Address - Country:US
Mailing Address - Phone:505-366-1022
Mailing Address - Fax:
Practice Address - Street 1:10001 COORS BYP NW
Practice Address - Street 2:APT 515
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-4024
Practice Address - Country:US
Practice Address - Phone:505-366-1022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLMT #6502174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist