Provider Demographics
NPI:1275089393
Name:RIVERA, CHRISTINA JO-DENEE (CRNA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JO-DENEE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 W 51ST ST S
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67217-5305
Mailing Address - Country:US
Mailing Address - Phone:918-978-7239
Mailing Address - Fax:
Practice Address - Street 1:1924 S UTICA AVE
Practice Address - Street 2:DAVIS TOWER, SUITE 600
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-6510
Practice Address - Country:US
Practice Address - Phone:918-978-7239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103840367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered