Healthcare Provider Details

I. General information

NPI: 1518133453
Provider Name (Legal Business Name): LORI ANN RIVERA N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 1ST AVE NURSING OFFICE
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

560 1ST AVE NURSING OFFICE
NEW YORK NY
10016-6402
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-7000
  • Fax: 212-263-2084
Mailing address:
  • Phone: 212-263-7000
  • Fax: 212-263-2084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number304688
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: