Provider Demographics
NPI:1164012480
Name:RIVERA, VANESSA (RN)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:GIARDINELLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:22 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-2534
Mailing Address - Country:US
Mailing Address - Phone:631-371-6108
Mailing Address - Fax:
Practice Address - Street 1:22 CEDAR ST
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-2534
Practice Address - Country:US
Practice Address - Phone:631-371-6108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY807956163W00000X
NYT7P2Q2X3183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No183700000XPharmacy Service ProvidersPharmacy Technician