Provider Demographics
NPI:1841582129
Name:RIVERA, TARA L (RN)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:L
Last Name:RIVERA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5302
Mailing Address - Country:US
Mailing Address - Phone:845-517-2870
Mailing Address - Fax:845-517-2871
Practice Address - Street 1:242 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5302
Practice Address - Country:US
Practice Address - Phone:845-517-2870
Practice Address - Fax:845-517-2871
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY551092-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse