Provider Demographics
NPI:1396079620
Name:RIVERA, CHRISTINE C (LPN)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:C
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 1:29 BUFFALO AVE APT 18
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-2316
Mailing Address - Country:US
Mailing Address - Phone:631-472-1748
Mailing Address - Fax:
Practice Address - Street 1:29 BUFFALO AVE APT 18
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-2316
Practice Address - Country:US
Practice Address - Phone:631-472-1748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-18
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272804164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse