Healthcare Provider Details

I. General information

NPI: 1497297808
Provider Name (Legal Business Name): JOY LARIVIERE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407B GIDNEY AVE
NEWBURGH NY
12550-3702
US

IV. Provider business mailing address

407 GIDNEY AVE SUITE B
NEWBURGH NY
12550-3741
US

V. Phone/Fax

Practice location:
  • Phone: 845-561-7075
  • Fax:
Mailing address:
  • Phone: 845-561-7075
  • Fax: 845-561-7006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF-340902
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: