Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | COA.16939-NP | OH |
NPI | 1003206913 |
---|---|
Provider Name | Jennifer Nicole Rivchun |
First Address | Woodmere, OH 44122-4522 |
Second Address | Woodmere, OH 44122-4522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2015 |
Last Update Date | 23/06/2021 |