Basic Information
| Provider Information | |||||||||
| NPI: | 1982214136 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LARIVIERE | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | MIDDLETON | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | AGACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1914 LELARAY ST | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809092800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037463465 | ||||||||
| FaxNumber: | 7196322925 | ||||||||
| Practice Location | |||||||||
| Address1: | 1914 LELARAY ST | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809092800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037463465 | ||||||||
| FaxNumber: | 7196322925 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2020 | ||||||||
| LastUpdateDate: | 04/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APN.0995529-NP | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2100X | APN.0995529-NP | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.