Healthcare Provider Details

I. General information

NPI: 1598106064
Provider Name (Legal Business Name): REBECCA RIVERA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USA MEDDAC BAVARIA CMR 411, BLDG 700, ROSE BARRACKS
APO AE
09112
US

IV. Provider business mailing address

USA MEDDAC BAVARIA CMR 411, BLDG 700, ROSE BARRACKS
APO AE
09112
US

V. Phone/Fax

Practice location:
  • Phone: 499662834719
  • Fax: 4999662834721
Mailing address:
  • Phone: 499662834719
  • Fax: 4999662834721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number9315098
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: