Healthcare Provider Details

I. General information

NPI: 1114231420
Provider Name (Legal Business Name): CHRISTIE MARIE RIVELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2158 EXCHANGE ST SUITE 304
ASTORIA OR
97103-3316
US

IV. Provider business mailing address

PO BOX 239
ASTORIA OR
97103-0239
US

V. Phone/Fax

Practice location:
  • Phone: 503-325-8315
  • Fax: 503-325-8602
Mailing address:
  • Phone: 503-325-8315
  • Fax: 503-325-8602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201250011NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: