Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN1007693 | DC |
NPI | 1003325721 |
---|---|
Provider Name | Ms. Desiree Rivas |
First Address | Fairfax, VA 22031 |
Second Address | Washington, DC 20002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2017 |
Last Update Date | 26/09/2017 |