Provider Demographics
NPI:1114231420
Name:RIVELLI, CHRISTIE MARIE
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:MARIE
Last Name:RIVELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 239
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-0239
Mailing Address - Country:US
Mailing Address - Phone:503-325-8315
Mailing Address - Fax:503-325-8602
Practice Address - Street 1:2158 EXCHANGE ST
Practice Address - Street 2:SUITE 304
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3316
Practice Address - Country:US
Practice Address - Phone:503-325-8315
Practice Address - Fax:503-325-8602
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201250011NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR231893Medicaid
OR381852Medicare Oscar/Certification