Provider Demographics
NPI:1881020402
Name:RIVERA, DONNA LYNN (APN, CNM)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LYNN
Last Name:RIVERA
Suffix:
Gender:F
Credentials:APN, CNM
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:LYNN
Other - Last Name:GOLDSCHMIDT, HORNBECK, BOSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4841 BORDEAUX DR
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-5645
Mailing Address - Country:US
Mailing Address - Phone:847-542-9834
Mailing Address - Fax:
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:STE 750
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3361
Practice Address - Country:US
Practice Address - Phone:847-981-3698
Practice Address - Fax:847-981-3625
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010714367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife