Provider Demographics
NPI:1891870390
Name:RIVES, GRACE WAYNETTE (RN)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:WAYNETTE
Last Name:RIVES
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 1:59 E PARK AVE. S.E.
Mailing Address - Street 2:
Mailing Address - City:MOORE HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33471
Mailing Address - Country:US
Mailing Address - Phone:863-946-1548
Mailing Address - Fax:
Practice Address - Street 1:956 US HIGHWAY 27 SOUTH
Practice Address - Street 2:
Practice Address - City:MOORE HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33471
Practice Address - Country:US
Practice Address - Phone:863-946-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3410352163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse