Provider Demographics
NPI:1881050458
Name:RIVERS, ANDREA MICHELLE (ANP)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:MICHELLE
Last Name:RIVERS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 PREAKNESS AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2533
Mailing Address - Country:US
Mailing Address - Phone:973-452-4674
Mailing Address - Fax:
Practice Address - Street 1:645 PREAKNESS AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2533
Practice Address - Country:US
Practice Address - Phone:973-452-4674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00600700363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health