Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | AP60315078 | WA |
NPI | 1306198536 |
---|---|
Provider Name | Ms. Joanna Marie Rives |
First Address | Salt Lake City, UT 84125-0608 |
Second Address | Seattle, WA 98122-5788 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2012 |
Last Update Date | 31/10/2013 |