Provider Demographics
NPI:1558127118
Name:RIVERS, YOLANDA MICHELLE
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:MICHELLE
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 1:3092 HIGHLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-8955
Mailing Address - Country:US
Mailing Address - Phone:614-266-8459
Mailing Address - Fax:
Practice Address - Street 1:3092 HIGHLAND PARK DR
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-8955
Practice Address - Country:US
Practice Address - Phone:614-266-8459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH000000000000172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker