Healthcare Provider Details

I. General information

NPI: 1447761432
Provider Name (Legal Business Name): LYNN MARIE RIVAS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 06/14/2025
Certification Date: 06/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 PATRIOT CT
HORTENSE GA
31543-8019
US

IV. Provider business mailing address

218 PATRIOT CT
HORTENSE GA
31543-8019
US

V. Phone/Fax

Practice location:
  • Phone: 626-487-6591
  • Fax:
Mailing address:
  • Phone: 626-487-6591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN262641
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License NumberRN262641
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN262641
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: