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General NPI Number Information
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NPI Number | 1497509939
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Entity Type | Individual
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Provider Name | KALEIGH ANNE RIVERSO RN
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Gender | Female
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Dates
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Enumeration Date | 04/12/2024
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 650 STATE ST
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City | WATERTOWN
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State | NY
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Zip | 13601-2839
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Country | US
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Telephone | 315-755-1251
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Fax | 315-291-6601
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Provider Business Mailing Address
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Address Line | 118 HINSDALE RD
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City | CAMILLUS
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State | NY
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Zip | 13031-1629
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Country | US
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Telephone | 131-525-4782
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number | 900965
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License Number State | NY
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