Healthcare Provider Details

I. General information

NPI: 1548424997
Provider Name (Legal Business Name): MARIA OLIVA RIVERA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA O RIVERA FNP-BC

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 TAURAT PL
MAHOPAC NY
10541-5108
US

IV. Provider business mailing address

PO BOX 352
JEFFERSON VALLEY NY
10535-0352
US

V. Phone/Fax

Practice location:
  • Phone: 845-526-2204
  • Fax: 845-603-6013
Mailing address:
  • Phone: 914-523-7711
  • Fax: 845-603-6013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF331014
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number301202
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: