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NPI Code Detail

MEDICARE: MRS. JENNIFER LYNN RIVENBURGH NP-P

MEDICARE: MRS. JENNIFER LYNN RIVENBURGH NP-P
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
1163W00000XRegistered Nurse720511NY
2363LP0808XPsychiatric/Mental Health Nurse PractitionerF402794NY

General Provider Information

NPI Number : 1952962185
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER LYNN RIVENBURGH NP-P
Provider Business Mailing Address
First Line : 11-21 BROADWAY ST
Second Line :
City : GLOVERSVILLE
State : NY
Zip : 12078-3964
Country : US
Telephone Number : 518-725-4310
Fax Number : 518-725-2988
Provider Business Practice Location Address
First Line : 11-21 BROADWAY ST
Second Line :
City : GLOVERSVILLE
State : NY
Zip : 12078-3964
Country : US
Telephone Number : 518-725-4310
Fax Number : 518-725-2988
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2019
Last Update Date : 09/25/2019

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