Provider Demographics
NPI:1124482336
Name:RIVERS, SHAUN (MSN RN)
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:
Last Name:RIVERS
Suffix:
Gender:F
Credentials:MSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S SYCAMORE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-5802
Mailing Address - Country:US
Mailing Address - Phone:804-324-5051
Mailing Address - Fax:
Practice Address - Street 1:700 S SYCAMORE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-5802
Practice Address - Country:US
Practice Address - Phone:804-324-5051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001146276364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0001146276OtherREGISTERED NURSE