Healthcare Provider Details

I. General information

NPI: 1407447378
Provider Name (Legal Business Name): MONIQUE DANIELLE LARIVIERE AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 CEDAR ST
HYANNIS MA
02601-3009
US

IV. Provider business mailing address

621 MAIN ST
WEST BARNSTABLE MA
02668-1128
US

V. Phone/Fax

Practice location:
  • Phone: 508-790-0611
  • Fax:
Mailing address:
  • Phone: 508-364-7734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN10004785
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR219303
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: