Provider Demographics
NPI:1912703489
Name:RIVERA, ELAINE
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:RIVERA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-5767
Mailing Address - Country:US
Mailing Address - Phone:308-370-4502
Mailing Address - Fax:
Practice Address - Street 1:1604 W 3RD ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-5767
Practice Address - Country:US
Practice Address - Phone:308-370-4502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider