Provider Demographics
NPI:1043924947
Name:RIVERA, IVETTE MARIE (LPN)
Entity type:Individual
Prefix:
First Name:IVETTE
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 1:5275 N ABBE RD
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44035-1451
Mailing Address - Country:US
Mailing Address - Phone:440-934-9158
Mailing Address - Fax:
Practice Address - Street 1:5275 N ABBE RD
Practice Address - Street 2:
Practice Address - City:SHEFFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44035-1451
Practice Address - Country:US
Practice Address - Phone:440-934-9158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR060834164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse