Provider Demographics
NPI:1952548562
Name:RIVERA, LUCY
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:RIVERA
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 1:2481 SHERIDAN DR
Mailing Address - Street 2:APT. 10
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-9446
Mailing Address - Country:US
Mailing Address - Phone:801-678-8687
Mailing Address - Fax:
Practice Address - Street 1:2481 SHERIDAN DR
Practice Address - Street 2:APT. 10
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-9446
Practice Address - Country:US
Practice Address - Phone:801-678-8687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212151-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse