Provider Demographics
NPI:1205816311
Name:RIVERS, JENNIFER L (APRN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:RIVERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 ASYLUM AVENUE
Mailing Address - Street 2:SUITE 2109A
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105
Mailing Address - Country:US
Mailing Address - Phone:860-714-5058
Mailing Address - Fax:860-714-8311
Practice Address - Street 1:550 MAIN STREET
Practice Address - Street 2:HARTFORD CITY TOWN HALL
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103
Practice Address - Country:US
Practice Address - Phone:860-543-8602
Practice Address - Fax:860-722-8041
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2012-09-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA238002207RN0300X
CT003530207RN0300X
CT3530363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q45194Medicare UPIN