Provider Demographics
NPI:1629219571
Name:RIVERS, NICOLE (NRCMA)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:RIVERS
Suffix:
Gender:F
Credentials:NRCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2956 PIMA LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76119-2656
Mailing Address - Country:US
Mailing Address - Phone:817-714-1609
Mailing Address - Fax:
Practice Address - Street 1:2956 PIMA LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-2656
Practice Address - Country:US
Practice Address - Phone:817-714-1609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide