Individual
MS. CRYSTAL MARIE RIVERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.N
Contact information
Practice address
56 AVIS DR, HOLBROOK, NY 11741-2515
(631) 413-6252
Mailing address
56 AVIS DR, HOLBROOK, NY 11741-2515
(631) 413-6252
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
311644-1
NY
Other
Enumeration date
10/19/2012
Last updated
10/19/2012
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