Provider Demographics
NPI:1447945019
Name:RIVERA, TAHIRAH YVETTE
Entity type:Individual
Prefix:MRS
First Name:TAHIRAH
Middle Name:YVETTE
Last Name:RIVERA
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:PO BOX 9651
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30916-9651
Mailing Address - Country:US
Mailing Address - Phone:706-842-8115
Mailing Address - Fax:
Practice Address - Street 1:3909 CREST DR
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815-6114
Practice Address - Country:US
Practice Address - Phone:706-842-8115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider