Provider Demographics
NPI:1316183262
Name:RIVES, SUSAN LYNNE (LPN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LYNNE
Last Name:RIVES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:MISDOM
Other - Last Name:RIVES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:16825 TEQUESTA TRL
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34715-9466
Mailing Address - Country:US
Mailing Address - Phone:321-230-1951
Mailing Address - Fax:
Practice Address - Street 1:16825 TEQUESTA TRL
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34715-9466
Practice Address - Country:US
Practice Address - Phone:321-230-1951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-24
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN552801171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor