Individual
AJA SIMONE RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
24 JOLIET ST, DYER, IN 46311-1705
(219) 932-2300
Mailing address
2212 FREEDOM ST, PORTAGE, IN 46368-1417
(219) 746-6981
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28164192A
IN
367500000X
Certified Registered Nurse Anesthetist
Primary
28164192A
IN
Other
Enumeration date
06/05/2019
Last updated
12/02/2019
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