Provider Demographics
NPI:1376315317
Name:RIVERA, YESENIA MARIE
Entity Type:Individual
Prefix:
First Name:YESENIA
Middle Name:MARIE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 CARSWELL AVE
Mailing Address - Street 2:
Mailing Address - City:LACKLAND AFB
Mailing Address - State:TX
Mailing Address - Zip Code:78236-5514
Mailing Address - Country:US
Mailing Address - Phone:850-737-9290
Mailing Address - Fax:
Practice Address - Street 1:1940 CARSWELL AVE
Practice Address - Street 2:
Practice Address - City:LACKLAND AFB
Practice Address - State:TX
Practice Address - Zip Code:78236-5514
Practice Address - Country:US
Practice Address - Phone:850-737-9290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-148822163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse