WILBEN ANDY LARIVIERE PA
Complete NPI Record 1154076933
Physician Assistant - Medical in Mesa, AZ
Active since February 19, 2022
Complete NPI Dataset
This page contains the complete raw NPPES record for Wilben Andy Lariviere, PA (NPI 1154076933), an individual physician assistant provider in Mesa, AZ. All 28 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, Markdown or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1154076933 Field 1/28
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 1 Field 2/28
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Provider Last Name Legal Name: LARIVIERE Field 3/28
- The last name of the provider. If the provider is an individual, this is the legal name.
- Provider First Name: WILBEN Field 4/28
- The first name of the provider, if the provider is an individual.
- Provider Middle Name: ANDY Field 5/28
- The middle name of the provider, if the provider is an individual.
- Provider Credential Text: PA Field 6/28
- The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
- Provider First Line Business Mailing Address: 2045 S VINEYARD STE 119 Field 7/28
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: MESA Field 8/28
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: AZ Field 9/28
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 852106890 Field 10/28
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 11/28
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 4803004646 Field 12/28
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider First Line Business Practice Location Address: 2045 S VINEYARD STE 119 Field 13/28
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: MESA Field 14/28
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: AZ Field 15/28
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 852106890 Field 16/28
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 17/28
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 4803004646 Field 18/28
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 4803004646 Field 19/28
- The fax number associated with the location address of the provider being identified.
- Provider Gender Code: M Field 22/28
- The code designating the provider's gender if the provider is a person.
- Healthcare Provider Taxonomy Code 1: 363AM0700X Field 23/28
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Provider License Number 1: 1212-P.A. Field 24/28
- The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".
- Provider License Number State Code 1: PR Field 25/28
- The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.
- Healthcare Provider Primary Taxonomy Switch 1: Y Field 26/28
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Sole Proprietor: N Field 27/28
- Indicates whether the provider is registered as a sole proprietor. This is a single-character code: "Y" means the provider operates as a sole proprietor, and "N" means they do not.
Secondary Practice Locations 2
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
8260 NE 2nd Ave
Location 1/2Miami, FL 33138-3808 · Phone (305) 757-9555
333 W Thomas Rd Ste 208A
Location 2/2Phoenix, AZ 85013-4425 · Phone (480) 300-4646 · Fax (480) 210-5059
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