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General NPI Number Information
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NPI Number | 1891870390
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Entity Type | Individual
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Provider Name | GRACE WAYNETTE RIVES R.N.
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Gender | Female
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 08/10/2007
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Provider Practice Location Address
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Address Line | 956 US HIGHWAY 27 SOUTH
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City | MOORE HAVEN
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State | FL
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Zip | 33471
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Country | US
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Telephone | 863-946-0707
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Fax |
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Provider Business Mailing Address
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Address Line | 59 E PARK AVE. S.E.
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City | MOORE HAVEN
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State | FL
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Zip | 33471
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Country | US
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Telephone | 863-946-1548
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 3410352
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License Number State | FL
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