Provider Demographics
NPI:1164652483
Name:RIVELLINI, CHARLES GERALD JR (CRNA)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:GERALD
Last Name:RIVELLINI
Suffix:JR
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:15 RIMMON HILL RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-1322
Mailing Address - Country:US
Mailing Address - Phone:203-824-8482
Mailing Address - Fax:203-387-8397
Practice Address - Street 1:1157 SOUTH SR 7
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414
Practice Address - Country:US
Practice Address - Phone:561-795-3330
Practice Address - Fax:561-795-1030
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2014-09-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT000819367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered