Healthcare Provider Details

I. General information

NPI: 1184028276
Provider Name (Legal Business Name): LIZETTE ROVIRA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PENN ST
READING PA
19602-1000
US

IV. Provider business mailing address

120 PROSPECT ST
READING PA
19606-2871
US

V. Phone/Fax

Practice location:
  • Phone: 610-376-6988
  • Fax: 610-376-6944
Mailing address:
  • Phone: 610-376-6988
  • Fax: 610-376-6944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN662903
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: