Provider Demographics
NPI:1366006686
Name:KWIATKOWSKI, SHERILL RIVERA (RN)
Entity Type:Individual
Prefix:MS
First Name:SHERILL
Middle Name:RIVERA
Last Name:KWIATKOWSKI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 MT PLEASANT DR FL 2
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1993
Mailing Address - Country:US
Mailing Address - Phone:570-703-2135
Mailing Address - Fax:570-703-2082
Practice Address - Street 1:521 MT PLEASANT DR FL 2
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1993
Practice Address - Country:US
Practice Address - Phone:570-703-2135
Practice Address - Fax:570-703-2082
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN533673163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse