Provider Demographics
NPI:1831402197
Name:RIVERS, COLLEEN ROSEANN (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:ROSEANN
Last Name:RIVERS
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 SPARTANBURG HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-5840
Mailing Address - Country:US
Mailing Address - Phone:828-692-4223
Mailing Address - Fax:828-694-1600
Practice Address - Street 1:1200 SPARTANBURG HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-5840
Practice Address - Country:US
Practice Address - Phone:828-692-4223
Practice Address - Fax:828-694-1600
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL000252133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered