Doctor Name: | NICOLE RIVECCA |
NPI Number: | 1306096532 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 2337023 |
Business Practice Address: | 200 E Ryan Rd Suite 101 Oak Creek, WI - 531544533 |
Business Phone Number: | 4147680940 |
Business Fax Number: | |
Mailing Address: | 200 E Ryan Rd, Suite 101 OAK CREEK |
State: | WI |
Postal Code: | 531544533 |
Phone Number: | 4147680940 |
Fax Number: | |
NPI Enumeration Date: | 09/24/2008 |
NPI Last Update Date: | 11/17/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 2337023 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |