Provider Demographics
NPI:1134585680
Name:RIVAS, LISSETTE (LPN)
Entity type:Individual
Prefix:MS
First Name:LISSETTE
Middle Name:
Last Name:RIVAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 SIERRA VISTA LANE
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989
Mailing Address - Country:US
Mailing Address - Phone:845-220-2146
Mailing Address - Fax:845-220-2121
Practice Address - Street 1:405 SIERRA VISTA LANE
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989
Practice Address - Country:US
Practice Address - Phone:845-220-2146
Practice Address - Fax:845-220-2121
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250282-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse