Provider Demographics
NPI:1336515980
Name:RIVERA, EMMA VILORIA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:VILORIA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1871 STANHOPE ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-1556
Mailing Address - Country:US
Mailing Address - Phone:347-324-1067
Mailing Address - Fax:
Practice Address - Street 1:1871 STANHOPE ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-1556
Practice Address - Country:US
Practice Address - Phone:347-324-1067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY318583-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse