Provider Demographics
NPI:1497366959
Name:RIVERS, SAMANTHA D
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:D
Last Name:RIVERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 GOOD HOPE RD SE APT 421
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-5118
Mailing Address - Country:US
Mailing Address - Phone:202-640-8497
Mailing Address - Fax:
Practice Address - Street 1:2300 GOOD HOPE RD SE APT 421
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5118
Practice Address - Country:US
Practice Address - Phone:202-640-8497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0070738331Medicaid