Provider Demographics
NPI:1346464708
Name:RIVERA, SOUVENIR CULANCULAN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:SOUVENIR
Middle Name:CULANCULAN
Last Name:RIVERA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14820 W 81ST TER
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-4282
Mailing Address - Country:US
Mailing Address - Phone:913-406-6735
Mailing Address - Fax:
Practice Address - Street 1:PROVIDENCE MEDICAL CENTER
Practice Address - Street 2:8929 PARALLEL PARKWAY
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112
Practice Address - Country:US
Practice Address - Phone:913-596-4860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44447363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care