Provider Demographics
NPI:1205375201
Name:RIVERA, JOSEPH RYAN (RN)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RYAN
Last Name:RIVERA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18067-1635
Mailing Address - Country:US
Mailing Address - Phone:610-428-2696
Mailing Address - Fax:
Practice Address - Street 1:1441 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18067-1635
Practice Address - Country:US
Practice Address - Phone:610-428-2696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN597105163W00000X
PA26NR18486100163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse