Provider Demographics
NPI:1891460051
Name:RIVERA, TAINA AMARIS (LPN)
Entity type:Individual
Prefix:MS
First Name:TAINA
Middle Name:AMARIS
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 1:122 BURRITT RD
Mailing Address - Street 2:
Mailing Address - City:HILTON
Mailing Address - State:NY
Mailing Address - Zip Code:14468-9702
Mailing Address - Country:US
Mailing Address - Phone:315-427-5191
Mailing Address - Fax:
Practice Address - Street 1:122 BURRITT RD
Practice Address - Street 2:
Practice Address - City:HILTON
Practice Address - State:NY
Practice Address - Zip Code:14468-9702
Practice Address - Country:US
Practice Address - Phone:315-427-5191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331494164W00000X
NY331494-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse