Provider Demographics
NPI:1215749221
Name:RIVERA, CAITLIN MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:MARIE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SHELDON AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4124
Mailing Address - Country:US
Mailing Address - Phone:631-566-6427
Mailing Address - Fax:
Practice Address - Street 1:16 SHELDON AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4124
Practice Address - Country:US
Practice Address - Phone:631-566-6427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-25
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY735845163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse