Healthcare Provider Details

I. General information

NPI: 1104380500
Provider Name (Legal Business Name): RIVER FAMILY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2019
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25701 N LAKELAND BLVD STE 300
EUCLID OH
44132-2452
US

IV. Provider business mailing address

2074 WASHINGTON DR
RICHMOND HEIGHTS OH
44143-1357
US

V. Phone/Fax

Practice location:
  • Phone: 216-912-8993
  • Fax:
Mailing address:
  • Phone: 216-338-6548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MONIQUE WILLIAMS
Title or Position: FAMILY NURSE PRACTITIONER
Credential: FNP, NP-BC
Phone: 216-912-8993