Provider Demographics
NPI:1154771723
Name:CIARDULLO-RIVERA, JOANN MARIE (RN)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:MARIE
Last Name:CIARDULLO-RIVERA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JO-ANN
Other - Middle Name:MARIE
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:2 DUBLIN LN
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2014
Mailing Address - Country:US
Mailing Address - Phone:914-299-1583
Mailing Address - Fax:
Practice Address - Street 1:2 DUBLIN LN
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2014
Practice Address - Country:US
Practice Address - Phone:914-299-1583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY602840-1163W00000X
CT132845163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse