Healthcare Provider Details

I. General information

NPI: 1073403713
Provider Name (Legal Business Name): MERILYN RIVERA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 E LAKE ST
ADDISON IL
60101-2889
US

IV. Provider business mailing address

4429 N KILDARE AVE # 4G
CHICAGO IL
60630-4290
US

V. Phone/Fax

Practice location:
  • Phone: 630-835-1430
  • Fax:
Mailing address:
  • Phone: 915-258-7006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209.032662
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: