Provider Demographics
NPI:1881037216
Name:RIVERA, ULYSSA JOY (RN)
Entity Type:Individual
Prefix:
First Name:ULYSSA
Middle Name:JOY
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 1:508 KAITLYNN AVE
Mailing Address - Street 2:
Mailing Address - City:ANAMOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52205-7200
Mailing Address - Country:US
Mailing Address - Phone:319-481-0176
Mailing Address - Fax:
Practice Address - Street 1:508 KAITLYNN AVE
Practice Address - Street 2:
Practice Address - City:ANAMOSA
Practice Address - State:IA
Practice Address - Zip Code:52205-7200
Practice Address - Country:US
Practice Address - Phone:319-481-0176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA124717163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse