Provider Demographics
NPI:1265270466
Name:ORELLANA RIVEIRO, MARIA (LPN)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:ORELLANA RIVEIRO
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 1:1722 S 23RD ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-5506
Mailing Address - Country:US
Mailing Address - Phone:920-207-5197
Mailing Address - Fax:
Practice Address - Street 1:1031 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4900
Practice Address - Country:US
Practice Address - Phone:920-207-5197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-20
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI324452-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse