Provider Demographics
NPI:1386216125
Name:VIVANCO, NAOMI CATHERINE (NP-C)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:CATHERINE
Last Name:VIVANCO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 HAGAN DR
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-5016
Mailing Address - Country:US
Mailing Address - Phone:914-290-0212
Mailing Address - Fax:
Practice Address - Street 1:10 CRANBERRY DR
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-5367
Practice Address - Country:US
Practice Address - Phone:845-231-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF346831363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily