Provider Demographics
NPI:1811594955
Name:RIVERA, ADRIENNE MICHELLE (NP)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:MICHELLE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2156
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-5156
Mailing Address - Country:US
Mailing Address - Phone:209-848-1582
Mailing Address - Fax:
Practice Address - Street 1:232 W F ST
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3844
Practice Address - Country:US
Practice Address - Phone:209-848-2273
Practice Address - Fax:209-848-0242
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95045657163W00000X
CA95015572363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse