Provider Demographics
NPI:1407447378
Name:LARIVIERE, MONIQUE DANIELLE (AGACNP)
Entity type:Individual
Prefix:MISS
First Name:MONIQUE
Middle Name:DANIELLE
Last Name:LARIVIERE
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST BARNSTABLE
Mailing Address - State:MA
Mailing Address - Zip Code:02668-1128
Mailing Address - Country:US
Mailing Address - Phone:508-364-7734
Mailing Address - Fax:
Practice Address - Street 1:65 CEDAR ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3009
Practice Address - Country:US
Practice Address - Phone:508-790-0611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAPRN10004785363L00000X
MDR219303363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care