MEDICARE: RICHEL RUIVIVAR RN, FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F336872-1	NY

General Provider Information

NPI Number	:	1780961631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHEL RUIVIVAR RN, FNP-BC

Provider Business Mailing Address
First Line	:	27 EMMETT ST
Second Line	:	NEW HYDE PARK
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-2436
Country	:	US
Telephone Number	:	516-742-3806
Fax Number	:

Provider Business Practice Location Address
First Line	:	27 EMMETT ST
Second Line	:	NEW HYDE PARK
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-2436
Country	:	US
Telephone Number	:	516-742-3806
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2011
Last Update Date	:	11/07/2011

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