MEDICARE: JENNIFER L. RIVERS APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	238002	MA
2	207RN0300X	Nephrology Physician	003530	CT
3	363L00000X	Nurse Practitioner	3530	CT
4	363LF0000X	Family Nurse Practitioner	3530	CT

General Provider Information

NPI Number	:	1205816311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER L. RIVERS APRN

Provider Business Mailing Address
First Line	:	1000 ASYLUM AVENUE
Second Line	:	SUITE 2109A
City	:	HARTFORD
State	:	CT
Zip	:	06105
Country	:	US
Telephone Number	:	860-714-5058
Fax Number	:	860-714-8311

Provider Business Practice Location Address
First Line	:	550 MAIN STREET
Second Line	:	HARTFORD CITY TOWN HALL
City	:	HARTFORD
State	:	CT
Zip	:	06103
Country	:	US
Telephone Number	:	860-543-8602
Fax Number	:	860-722-8041

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	09/05/2012

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