Healthcare Provider Details

I. General information

NPI: 1275446056
Provider Name (Legal Business Name): WENDY MARIE RIVERA LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7071 WARBOYS RD
BERGEN NY
14416-9581
US

IV. Provider business mailing address

8 REDWOOD AVE # 507
ALBION NY
14411-1061
US

V. Phone/Fax

Practice location:
  • Phone: 585-494-6016
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number224902-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: