Provider Demographics
NPI:1174260483
Name:RIVERS, NICOLA (PMHNP)
Entity Type:Individual
Prefix:
First Name:NICOLA
Middle Name:
Last Name:RIVERS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:MRS
Other - First Name:NICOLA
Other - Middle Name:
Other - Last Name:RIVERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP
Mailing Address - Street 1:329 MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12209-2013
Mailing Address - Country:US
Mailing Address - Phone:252-525-3882
Mailing Address - Fax:
Practice Address - Street 1:1205 TROY SCHENECTADY RD STE 101
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1074
Practice Address - Country:US
Practice Address - Phone:518-348-3176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY403967363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY403967OtherNP LICENSE