Provider Demographics
NPI:1770451452
Name:WATHEN, MERCY RIVERA
Entity type:Individual
Prefix:MRS
First Name:MERCY
Middle Name:RIVERA
Last Name:WATHEN
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 1:1616 BRIDLE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-8517
Mailing Address - Country:US
Mailing Address - Phone:757-618-9851
Mailing Address - Fax:
Practice Address - Street 1:1616 BRIDLE CREEK CT
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-8517
Practice Address - Country:US
Practice Address - Phone:757-618-9851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-25
Last Update Date:2025-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA20254625P374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty