Provider Demographics
NPI:1356745087
Name:RIVERS, LISETTE
Entity type:Individual
Prefix:MS
First Name:LISETTE
Middle Name:
Last Name:RIVERS
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 1:6915 MODERN WAY
Mailing Address - Street 2:STE-1111
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-6723
Mailing Address - Country:US
Mailing Address - Phone:704-561-1098
Mailing Address - Fax:
Practice Address - Street 1:6915 MODERN WAY
Practice Address - Street 2:STE-1111
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-6723
Practice Address - Country:US
Practice Address - Phone:704-561-1098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-09
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide