Healthcare Provider Details

I. General information

NPI: 1144936691
Provider Name (Legal Business Name): JOSHUA PAUL LARIVIERE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 LIBERTY ST
SPRINGFIELD MA
01104-3779
US

IV. Provider business mailing address

395 LIBERTY ST
SPRINGFIELD MA
01104-3779
US

V. Phone/Fax

Practice location:
  • Phone: 413-419-5410
  • Fax:
Mailing address:
  • Phone: 413-419-5410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberE0914836
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2377548
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: