Doctor Name: | MICHAEL CUE RIVERA |
NPI Number: | 1427043132 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | FNP |
License Number: | 209002421 |
Business Practice Address: | 1110 Mulliken St Carlyle, IL - 622311233 |
Business Phone Number: | 6185943613 |
Business Fax Number: | 8888594347 |
Mailing Address: | 1110 Mulliken St, CARLYLE |
State: | IL |
Postal Code: | 622311233 |
Phone Number: | 6185943613 |
Fax Number: | 8888594347 |
NPI Enumeration Date: | 09/19/2005 |
NPI Last Update Date: | 09/24/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 209002421 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |