Provider Demographics
NPI:1942562178
Name:RIVENBURGH, TIFFANY AUTUMN (NP)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:AUTUMN
Last Name:RIVENBURGH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 COURT ST
Mailing Address - Street 2:SUITE 42
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1697
Mailing Address - Country:US
Mailing Address - Phone:607-337-1600
Mailing Address - Fax:607-334-4519
Practice Address - Street 1:5 COURT ST
Practice Address - Street 2:SUITE 42
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1697
Practice Address - Country:US
Practice Address - Phone:607-337-1600
Practice Address - Fax:607-334-4519
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337325363LF0000X
NY401881363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily