Provider Demographics
NPI:1740527423
Name:VASQUEZ RIVERA, MARIA BROOK (RN)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:BROOK
Last Name:VASQUEZ RIVERA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-3001
Mailing Address - Country:US
Mailing Address - Phone:715-551-9340
Mailing Address - Fax:
Practice Address - Street 1:614 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-3001
Practice Address - Country:US
Practice Address - Phone:715-551-9340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI178708-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse