Provider Demographics
NPI:1548863905
Name:RIVERA, ALLISON N (RD)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:N
Last Name:RIVERA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 VIKING DR
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-9345
Mailing Address - Country:US
Mailing Address - Phone:307-899-2247
Mailing Address - Fax:
Practice Address - Street 1:20 VIKING DR
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-9345
Practice Address - Country:US
Practice Address - Phone:307-899-2247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY295133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty