Provider Demographics
NPI:1801928510
Name:RIVAS, SUSAN ANNE (RN, APN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANNE
Last Name:RIVAS
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:22 N FRANKLIN BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-2547
Mailing Address - Country:US
Mailing Address - Phone:609-272-0655
Mailing Address - Fax:609-272-9317
Practice Address - Street 1:4013 ROUTE 9 N
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-4021
Practice Address - Country:US
Practice Address - Phone:732-905-5255
Practice Address - Fax:732-905-5266
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR102449163W00000X
NJ26NJ000048363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP77576Medicare UPIN