Individual
CARLY RIVAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
239 MAIN ST, CORNWALL, NY 12518-1564
(845) 652-3405
Mailing address
239 MAIN ST, CORNWALL, NY 12518-1564
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
649418-1
NY
Other
Enumeration date
12/21/2012
Last updated
12/21/2012
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