Provider Demographics
NPI:1023675642
Name:RIVAS LOREK, RENA FRANCES
Entity type:Individual
Prefix:
First Name:RENA
Middle Name:FRANCES
Last Name:RIVAS LOREK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 BURNTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45430-1654
Mailing Address - Country:US
Mailing Address - Phone:219-226-5353
Mailing Address - Fax:
Practice Address - Street 1:5130 SALEM AVE
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-2042
Practice Address - Country:US
Practice Address - Phone:937-529-4443
Practice Address - Fax:937-715-4363
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28163642A163W00000X, 207Q00000X, 363LF0000X
IN71009106A363L00000X
OH0036834363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner