Provider Demographics
NPI:1336493386
Name:RIVADELO, SONIA (RN MSN ANP-BC CCRN-C)
Entity Type:Individual
Prefix:MRS
First Name:SONIA
Middle Name:
Last Name:RIVADELO
Suffix:
Gender:F
Credentials:RN MSN ANP-BC CCRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-3049
Mailing Address - Country:US
Mailing Address - Phone:201-880-4960
Mailing Address - Fax:
Practice Address - Street 1:230 E RIDGEWOOD
Practice Address - Street 2:BERGEN REGIONAL MEDICAL CENTER
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652
Practice Address - Country:US
Practice Address - Phone:201-967-4151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00393600363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health