Provider Demographics
NPI:1447761432
Name:RIVAS, LYNN MARIE (RN)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:RIVAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SUNNYDALE LN
Mailing Address - Street 2:
Mailing Address - City:PORT WENTWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:31407-3630
Mailing Address - Country:US
Mailing Address - Phone:912-315-2280
Mailing Address - Fax:912-315-3664
Practice Address - Street 1:TUTTLE ARMY HEALTH CLINIC
Practice Address - Street 2:230 DUNCAN DR., BLDG. 1440
Practice Address - City:HAAF
Practice Address - State:GA
Practice Address - Zip Code:31409
Practice Address - Country:US
Practice Address - Phone:912-315-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN262641163WC0400X, 163WX0106X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WX0106XNursing Service ProvidersRegistered NurseOccupational Health