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General NPI Number Information
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NPI Number | 1659982221
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Entity Type | Individual
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Provider Name | ALICIA VON RIVENBURGH FNP
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Gender | Female
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Dates
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Enumeration Date | 08/16/2020
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Last Update Date | 08/16/2020
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Provider Practice Location Address
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Address Line | 3155 E 104TH AVE UNIT 6A
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City | THORNTON
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State | CO
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Zip | 80233-4231
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Country | US
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Telephone | 651-307-9720
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Fax |
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Provider Business Mailing Address
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Address Line | 3155 E 104TH AVE UNIT 6A
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City | THORNTON
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State | CO
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Zip | 80233-4231
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Country | US
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Telephone | 651-307-9720
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0995630
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License Number State | CO
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