Provider Demographics
NPI:1881845469
Name:RIVERA, MINERVA (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:MINERVA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-4608
Mailing Address - Country:US
Mailing Address - Phone:617-833-4120
Mailing Address - Fax:
Practice Address - Street 1:26 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-4608
Practice Address - Country:US
Practice Address - Phone:617-833-4120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR023935163W00000X
FLRN9229437163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse