Individual
LISA A RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1000 COMMERCIAL LN, SUFFOLK, VA 23434-8148
(757) 942-1025
(757) 925-3504
Mailing address
5268 GODWIN BLVD, SUFFOLK, VA 23434-8114
(757) 255-7117
(757) 255-7139
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
0024167690
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004945310
—
VA
Enumeration date
04/01/2008
Last updated
01/04/2013
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