Provider Demographics
NPI:1952020760
Name:RIVERS, DENISE JOLYNN (LPN)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:JOLYNN
Last Name:RIVERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 NORTH US 1HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379
Mailing Address - Country:US
Mailing Address - Phone:910-719-4335
Mailing Address - Fax:910-434-8668
Practice Address - Street 1:523 NORTH US 1HWY
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379
Practice Address - Country:US
Practice Address - Phone:910-719-4335
Practice Address - Fax:910-434-8668
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC045254164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
045254OtherNO NUMBERS