Provider Information for 1649281635
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LISA RIVERS MA, LP
Sex: Female
NPI: 1649281635
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1649281635 | ||||||||||||
| Enumeration Date | 2006-08-11 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 1001 HIGHWAY 7 ROOM 217 HOPKINS, MN 55305-4723 United States Phone: 952-988-4177 | Fax:952-988-6728 | ||||||||||||
| Primary Practice Address | 1001 HIGHWAY 7 ROOM 217 HOPKINS, MN 55305-4723 United States Phone: 952-988-4177 | Fax:952-988-6728 | ||||||||||||
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