Individual
JACKIE RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
807 N PROVIDENCE RD, COLUMBIA, MO 65203-4359
(573) 443-8706
Mailing address
807 N PROVIDENCE RD, COLUMBIA, MO 65203-4359
(573) 443-8706
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
2010009084
MO
Other
Enumeration date
08/23/2016
Last updated
08/23/2016
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