Provider Demographics
NPI:1639919897
Name:MCLAIN, RIVA (LPN)
Entity type:Individual
Prefix:MS
First Name:RIVA
Middle Name:
Last Name:MCLAIN
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 1:1127 W HADLEY ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53206-2642
Mailing Address - Country:US
Mailing Address - Phone:414-881-4094
Mailing Address - Fax:414-921-1831
Practice Address - Street 1:423 W CENTER ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-2724
Practice Address - Country:US
Practice Address - Phone:414-881-4094
Practice Address - Fax:414-921-1831
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI327673-31164W00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No164W00000XNursing Service ProvidersLicensed Practical Nurse