Healthcare Provider Details

I. General information

NPI: 1144859562
Provider Name (Legal Business Name): HENRY RIVERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

394 BAR HARBOR RD
TRENTON ME
04605-5807
US

IV. Provider business mailing address

8 RUGER WAY STE 3C
ELLSWORTH ME
04605-2120
US

V. Phone/Fax

Practice location:
  • Phone: 207-667-5899
  • Fax:
Mailing address:
  • Phone: 786-372-2001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP201155
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11005577
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: