Healthcare Provider Details

I. General information

NPI: 1669847513
Provider Name (Legal Business Name): NUPUR RAJESH RIVERA MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2015
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 GRAND CORNER AVE STE A
GAITHERSBURG MD
20878-7332
US

IV. Provider business mailing address

15205 GRAVENHURST TER
NORTH POTOMAC MD
20878-3421
US

V. Phone/Fax

Practice location:
  • Phone: 301-545-2148
  • Fax:
Mailing address:
  • Phone: 703-328-7023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR246312
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number253507
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: