Provider Demographics
NPI:1104311166
Name:RIVERA, WHITNEY (RN, LPN)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:RN, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 N MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44509-1227
Mailing Address - Country:US
Mailing Address - Phone:330-797-0070
Mailing Address - Fax:330-797-9146
Practice Address - Street 1:550 W CHALMERS AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44511-1576
Practice Address - Country:US
Practice Address - Phone:330-797-0070
Practice Address - Fax:330-797-9146
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.489396163WA0400X, 163W00000X
OH163159164W00000X
OHLPN.163159.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No164W00000XNursing Service ProvidersLicensed Practical Nurse