Provider Demographics
NPI:1861145724
Name:RIVERS, STEPHANIE D (RN)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:D
Last Name:RIVERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:D
Other - Last Name:RIVERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:43380 QUAIL ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20636-4111
Mailing Address - Country:US
Mailing Address - Phone:301-710-2810
Mailing Address - Fax:
Practice Address - Street 1:43380 QUAIL ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:MD
Practice Address - Zip Code:20636-4111
Practice Address - Country:US
Practice Address - Phone:240-587-7186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR195025163W00000X, 163WA2000X, 163WC1500X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health