Provider Demographics
NPI:1508440371
Name:RIVER, GEOFFREY F (APN)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:F
Last Name:RIVER
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1749 BROWN AVE
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:IN
Mailing Address - Zip Code:46394-1434
Mailing Address - Country:US
Mailing Address - Phone:219-473-1921
Mailing Address - Fax:
Practice Address - Street 1:1749 BROWN AVE
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:IN
Practice Address - Zip Code:46394-1434
Practice Address - Country:US
Practice Address - Phone:219-473-1921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.6226665163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency