Provider Demographics
NPI:1790101178
Name:RIVERS, ATHENA (EDS)
Entity Type:Individual
Prefix:
First Name:ATHENA
Middle Name:
Last Name:RIVERS
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 E 34TH ST
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44055-2027
Mailing Address - Country:US
Mailing Address - Phone:440-277-1240
Mailing Address - Fax:
Practice Address - Street 1:2319 E 34TH ST
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-2027
Practice Address - Country:US
Practice Address - Phone:440-277-1240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist