MEDICARE: DR. MONIQUE MICHELLE RIVERS DBH, MSN, RN

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	163W00000X	Registered Nurse	RN127712	AZ

General Provider Information

NPI Number	:	1417443821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONIQUE MICHELLE RIVERS DBH, MSN, RN

Provider Business Mailing Address
First Line	:	16084 W CLINTON ST
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85379-4683
Country	:	US
Telephone Number	:	623-760-5810
Fax Number	:

Provider Business Practice Location Address
First Line	:	8607 N 59TH AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-5433
Country	:	US
Telephone Number	:	623-760-5810
Fax Number	:

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

Provider Enumeration Date	:	07/09/2018
Last Update Date	:	07/09/2018

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