Provider Demographics
NPI:1215290002
Name:RIVERA, LYNDA LORRAINE (LPN)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:LORRAINE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SHILOH SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-3123
Mailing Address - Country:US
Mailing Address - Phone:937-389-6513
Mailing Address - Fax:
Practice Address - Street 1:40 SHILOH SPRINGS RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-3123
Practice Address - Country:US
Practice Address - Phone:937-389-6513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.112007164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse