Provider Demographics
NPI:1417443821
Name:RIVERS, MONIQUE MICHELLE (DBH, MSN, RN)
Entity Type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:MICHELLE
Last Name:RIVERS
Suffix:
Gender:F
Credentials:DBH, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16084 W CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-4683
Mailing Address - Country:US
Mailing Address - Phone:623-760-5810
Mailing Address - Fax:
Practice Address - Street 1:8607 N 59TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-5433
Practice Address - Country:US
Practice Address - Phone:623-760-5810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN127712163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse