Provider Demographics
NPI:1891199840
Name:RIVERA, JENNIFER DIONISIA (DOULA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DIONISIA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 VINE ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:GA
Mailing Address - Zip Code:30268-1425
Mailing Address - Country:US
Mailing Address - Phone:404-932-9154
Mailing Address - Fax:
Practice Address - Street 1:206 VINE ST
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:GA
Practice Address - Zip Code:30268-1425
Practice Address - Country:US
Practice Address - Phone:404-932-9154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula