Provider Demographics
NPI:1194357962
Name:RIVERS, LESLEY GENEVIEVE
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:GENEVIEVE
Last Name:RIVERS
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 1:142 SAMFORD ST
Mailing Address - Street 2:
Mailing Address - City:ALBERTA
Mailing Address - State:VA
Mailing Address - Zip Code:23821-2334
Mailing Address - Country:US
Mailing Address - Phone:804-617-6457
Mailing Address - Fax:
Practice Address - Street 1:142 SAMFORD ST
Practice Address - Street 2:
Practice Address - City:ALBERTA
Practice Address - State:VA
Practice Address - Zip Code:23821-2334
Practice Address - Country:US
Practice Address - Phone:804-617-6457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5678OtherNON EMERGENCY MEDICAL TRANSPORTATION