Provider Demographics
NPI:1265906945
Name:RIVERA-BEATY, ANTONIA (LPN)
Entity type:Individual
Prefix:MRS
First Name:ANTONIA
Middle Name:
Last Name:RIVERA-BEATY
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 1:29 VALLEY VIEW PL
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-4515
Mailing Address - Country:US
Mailing Address - Phone:585-491-7058
Mailing Address - Fax:
Practice Address - Street 1:29 VALLEY VIEW PL
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-4515
Practice Address - Country:US
Practice Address - Phone:585-491-7058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308969164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse