Provider Demographics
NPI:1437451903
Name:RIVERA, ASHLEY CEREZO (APRN-RX)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CEREZO
Last Name:RIVERA
Suffix:
Gender:F
Credentials:APRN-RX
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 PAAILUNA WAY
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-1409
Mailing Address - Country:US
Mailing Address - Phone:808-466-9113
Mailing Address - Fax:808-427-3131
Practice Address - Street 1:1790 PAAILUNA WAY
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782
Practice Address - Country:US
Practice Address - Phone:808-466-9113
Practice Address - Fax:808-427-3131
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN57478363LG0600X
HIAPRN1326363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology