Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 44447 | KS |
NPI | 1346464708 |
---|---|
Provider Name | Mrs. Souvenir Culanculan Rivera |
First Address | Lenexa, KS 66215-4282 |
Second Address | Kansas City, KS 66112 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 08/07/2007 |