Basic Information
| Provider Information | |||||||||
| NPI: | 1699043307 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIVINUS | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 WEST MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HOPKINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085303140 | ||||||||
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| Practice Location | |||||||||
| Address1: | 50 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HOPKINTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017481672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085303140 | ||||||||
| FaxNumber: | 6038938886 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2011 | ||||||||
| LastUpdateDate: | 02/24/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN148420 | MA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 363L00000X | RN148420 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.