Provider Demographics
NPI:1790240141
Name:RIVAS, MIRIANNYS (FNP-C)
Entity Type:Individual
Prefix:
First Name:MIRIANNYS
Middle Name:
Last Name:RIVAS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 BROAD ST STE 201
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-1444
Mailing Address - Country:US
Mailing Address - Phone:401-642-0100
Mailing Address - Fax:833-992-2318
Practice Address - Street 1:655 BROAD ST STE 201
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-1444
Practice Address - Country:US
Practice Address - Phone:401-390-0734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN02001363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily