Provider Demographics
NPI:1073869475
Name:RIVA-FOSTER, KATHERINE ROSE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ROSE
Last Name:RIVA-FOSTER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:ROSE
Other - Last Name:ZELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1401 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MENDOTA
Mailing Address - State:IL
Mailing Address - Zip Code:61342-9216
Mailing Address - Country:US
Mailing Address - Phone:815-539-1607
Mailing Address - Fax:
Practice Address - Street 1:1401 E 12TH ST
Practice Address - Street 2:
Practice Address - City:MENDOTA
Practice Address - State:IL
Practice Address - Zip Code:61342
Practice Address - Country:US
Practice Address - Phone:815-343-1925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-009634207L00000X
IL041.328911367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology