Healthcare Provider Details

I. General information

NPI: 1407452543
Provider Name (Legal Business Name): LATORIA RIVERS MCVAY BSN, RNC - NIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TORI R MCVAY BSN, RNC - NIC

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 WOODLAND AVE
SATSUMA AL
36572-2204
US

IV. Provider business mailing address

PO BOX 404
SATSUMA AL
36572-0404
US

V. Phone/Fax

Practice location:
  • Phone: 251-210-8657
  • Fax: 866-594-3797
Mailing address:
  • Phone: 251-210-8657
  • Fax: 866-594-3797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-148460
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: