Provider Demographics
NPI:1215345921
Name:RIVILLAS-O'NEILL, JENNY PATRICIA (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:PATRICIA
Last Name:RIVILLAS-O'NEILL
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 ARLINGTON ST STE 500
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3986
Mailing Address - Country:US
Mailing Address - Phone:617-816-0094
Mailing Address - Fax:
Practice Address - Street 1:200 SPRINGS ROAD
Practice Address - Street 2:EDITH NOURSE ROGERS VA
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730
Practice Address - Country:US
Practice Address - Phone:617-687-3872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2259385163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse