Individual
JESSICA RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
HWY 160 MP 394.3, KAYENTA, AZ 86033-0368
(928) 697-4100
Mailing address
PO BOX 368, KAYENTA, AZ 86033-0368
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN147888
LA
163WE0003X
Emergency Registered Nurse
RN147888
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0300073
MEDICARE OSCAR/CERTIFICATION
AZ
05
—
060012
—
AZ
01
—
HSZ045
MEDICARE PIN
AZ
Enumeration date
06/24/2019
Last updated
06/24/2019
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