Provider Demographics
NPI:1669925418
Name:RIVAS, GRETCHEN (L AC)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:RIVAS
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4004 OLEANDER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6853
Mailing Address - Country:US
Mailing Address - Phone:910-262-1122
Mailing Address - Fax:910-399-1448
Practice Address - Street 1:4004 OLEANDER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6853
Practice Address - Country:US
Practice Address - Phone:910-262-1122
Practice Address - Fax:910-399-1448
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC633171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist