Provider Demographics
NPI:1790487536
Name:RIVERS, TANESHA (LVN)
Entity Type:Individual
Prefix:
First Name:TANESHA
Middle Name:
Last Name:RIVERS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6431 LOS ROBLES AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-3061
Mailing Address - Country:US
Mailing Address - Phone:714-640-1771
Mailing Address - Fax:
Practice Address - Street 1:6431 LOS ROBLES AVE APT 6
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-3061
Practice Address - Country:US
Practice Address - Phone:714-640-1771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA286227164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse