Provider Demographics
NPI:1508266958
Name:RIVKIS, NORA GAYLE (LMP)
Entity Type:Individual
Prefix:
First Name:NORA
Middle Name:GAYLE
Last Name:RIVKIS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:NAOMI
Other - Middle Name:
Other - Last Name:RIVKIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:4126 37TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-2624
Mailing Address - Country:US
Mailing Address - Phone:206-538-7099
Mailing Address - Fax:
Practice Address - Street 1:4126 37TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-2624
Practice Address - Country:US
Practice Address - Phone:206-538-7099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60415545174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist