Provider Demographics
NPI:1659592657
Name:RIVERA, JOHANNE L (LPN)
Entity Type:Individual
Prefix:MISS
First Name:JOHANNE
Middle Name:L
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 URB. VILLA BLANCA
Mailing Address - Street 2:C DIAMANTE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-704-9699
Mailing Address - Fax:787-761-1947
Practice Address - Street 1:URB PURPLE TREE 488 CARR 845
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-761-1945
Practice Address - Fax:787-761-1947
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR333068164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse