Provider Demographics
NPI:1346380052
Name:RIVERA, KAREN M (RN)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:M
Last Name:RIVERA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:M
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1404 E LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOREB
Mailing Address - State:WI
Mailing Address - Zip Code:53572-2012
Mailing Address - Country:US
Mailing Address - Phone:414-795-5516
Mailing Address - Fax:
Practice Address - Street 1:1404 E LINCOLN ST
Practice Address - Street 2:
Practice Address - City:MOUNT HOREB
Practice Address - State:WI
Practice Address - Zip Code:53572-2012
Practice Address - Country:US
Practice Address - Phone:414-795-5516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40001600Medicaid