Provider Demographics
NPI:1184419442
Name:RIVERA, KATELYN AARIEL
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:AARIEL
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 PARK AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6010
Mailing Address - Country:US
Mailing Address - Phone:201-616-9266
Mailing Address - Fax:
Practice Address - Street 1:179 E 116TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-1459
Practice Address - Country:US
Practice Address - Phone:201-616-9266
Practice Address - Fax:201-616-9266
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309213-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse