Healthcare Provider Details

I. General information

NPI: 1699225656
Provider Name (Legal Business Name): CARMELITA RIVERO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CTR 9040A JACKSON AVE, ATTN: MCHJ-CLQ-C
TACOMA WA
98431-1100
US

IV. Provider business mailing address

3730 N BENNETT ST
TACOMA WA
98407-3535
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-0895
  • Fax: 253-968-1222
Mailing address:
  • Phone: 253-759-3240
  • Fax: 253-968-1222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN00124761
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: