Provider Demographics
NPI:1407452543
Name:MCVAY, LATORIA RIVERS (BSN, RNC - NIC)
Entity Type:Individual
Prefix:
First Name:LATORIA
Middle Name:RIVERS
Last Name:MCVAY
Suffix:
Gender:F
Credentials:BSN, RNC - NIC
Other - Prefix:MRS
Other - First Name:TORI
Other - Middle Name:R
Other - Last Name:MCVAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSN, RNC - NIC
Mailing Address - Street 1:PO BOX 404
Mailing Address - Street 2:
Mailing Address - City:SATSUMA
Mailing Address - State:AL
Mailing Address - Zip Code:36572-0404
Mailing Address - Country:US
Mailing Address - Phone:251-210-8657
Mailing Address - Fax:866-594-3797
Practice Address - Street 1:57 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:SATSUMA
Practice Address - State:AL
Practice Address - Zip Code:36572-2204
Practice Address - Country:US
Practice Address - Phone:251-210-8657
Practice Address - Fax:866-594-3797
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-148460163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse