Provider Demographics
NPI:1801196316
Name:RIVERS, CARLA DENEEN
Entity Type:Individual
Prefix:MISS
First Name:CARLA
Middle Name:DENEEN
Last Name:RIVERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19870 MONTEREY AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1513
Mailing Address - Country:US
Mailing Address - Phone:216-394-7937
Mailing Address - Fax:
Practice Address - Street 1:19870 MONTEREY AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44119-1513
Practice Address - Country:US
Practice Address - Phone:216-394-7937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-31
Last Update Date:2010-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH133044164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse