Healthcare Provider Details

I. General information

NPI: 1013108182
Provider Name (Legal Business Name): KRISTINE M. RIVERA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINE M TRAINOR CRNA

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N MIDLAND AVE NYACK HOSPITAL
NYACK NY
10960-1912
US

IV. Provider business mailing address

43 KENSICO DR 2ND FLOOR
MOUNT KISCO NY
10549-1009
US

V. Phone/Fax

Practice location:
  • Phone: 845-348-2862
  • Fax:
Mailing address:
  • Phone: 914-666-8866
  • Fax: 914-666-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number466039
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: