Provider Demographics
NPI:1467934901
Name:RIVERO, AMELIA (LPN)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:RIVERO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:CHINOOK
Mailing Address - State:WA
Mailing Address - Zip Code:98614-0248
Mailing Address - Country:US
Mailing Address - Phone:360-607-6310
Mailing Address - Fax:
Practice Address - Street 1:744 WATER STREET
Practice Address - Street 2:
Practice Address - City:CHINOOK
Practice Address - State:WA
Practice Address - Zip Code:98614
Practice Address - Country:US
Practice Address - Phone:360-607-6310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00031363164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse