Provider Demographics
NPI:1649571308
Name:RIVERS, CHASITY MARIE (LPN)
Entity type:Individual
Prefix:
First Name:CHASITY
Middle Name:MARIE
Last Name:RIVERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6825 STATE ROUTE 22
Mailing Address - Street 2:APT 1
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-4915
Mailing Address - Country:US
Mailing Address - Phone:518-578-7385
Mailing Address - Fax:
Practice Address - Street 1:6825 STATE ROUTE 22
Practice Address - Street 2:APT 1
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-4915
Practice Address - Country:US
Practice Address - Phone:518-578-7385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302710-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse