Provider Demographics
NPI:1407447378
Name:LARIVIERE, MONIQUE DANIELLE (AGACNP)
Entity Type:Individual
Prefix:MISS
First Name:MONIQUE
Middle Name:DANIELLE
Last Name:LARIVIERE
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MONACO TER APT I
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-3878
Mailing Address - Country:US
Mailing Address - Phone:508-364-7734
Mailing Address - Fax:
Practice Address - Street 1:2003 MEDICAL PKWY STE 310
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7944
Practice Address - Country:US
Practice Address - Phone:443-951-4277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR219303363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care