Provider Demographics
NPI:1679941140
Name:RIVERA, VIRGINIA MARIE (LPN)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:MARIE
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 1:8687 E VIA DE VENTURA
Mailing Address - Street 2:SUITE #110
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3347
Mailing Address - Country:US
Mailing Address - Phone:480-609-9000
Mailing Address - Fax:480-609-9021
Practice Address - Street 1:8687 E VIA DE VENTURA
Practice Address - Street 2:SUITE #110
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3347
Practice Address - Country:US
Practice Address - Phone:480-609-9000
Practice Address - Fax:480-609-9021
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP047403164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse