Healthcare Provider Details

I. General information

NPI: 1194397398
Provider Name (Legal Business Name): JESSICA RIVET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 HIGH WATCH RD
EFFINGHAM NH
03882-8336
US

IV. Provider business mailing address

235 AFRICA RD
ALTON NH
03809-5105
US

V. Phone/Fax

Practice location:
  • Phone: 866-652-8889
  • Fax:
Mailing address:
  • Phone: 603-716-5178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number064890-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: