Healthcare Provider Details

I. General information

NPI: 1205995529
Provider Name (Legal Business Name): WILLIAM CARL RIVERA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 12/30/2023
Certification Date: 12/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 LANGLEY PKWY
CONCORD NH
03301-7521
US

IV. Provider business mailing address

4 CHADDARIN LN
PLYMOUTH NH
03264-4400
US

V. Phone/Fax

Practice location:
  • Phone: 603-228-7211
  • Fax:
Mailing address:
  • Phone: 202-441-7512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN59997
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR115089
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024165528
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number084359-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: