Provider Demographics
NPI:1659982221
Name:VON RIVENBURGH, ALICIA (FNP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:VON RIVENBURGH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:NEUMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3155 E 104TH AVE UNIT 6A
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-4231
Mailing Address - Country:US
Mailing Address - Phone:651-307-9720
Mailing Address - Fax:
Practice Address - Street 1:3155 E 104TH AVE UNIT 6A
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-4231
Practice Address - Country:US
Practice Address - Phone:651-307-9720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-16
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0995630363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily