Provider Demographics
NPI:1124420039
Name:RIVERS-HEATH, DANA M (NP)
Entity type:Individual
Prefix:MS
First Name:DANA
Middle Name:M
Last Name:RIVERS-HEATH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2-22 HARTLEY PLACE
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3047
Mailing Address - Country:US
Mailing Address - Phone:201-797-0741
Mailing Address - Fax:
Practice Address - Street 1:2-22 HARTLEY PLACE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3047
Practice Address - Country:US
Practice Address - Phone:201-797-0741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY561958-1163W00000X
NY338065363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner