Healthcare Provider Details

I. General information

NPI: 1649082058
Provider Name (Legal Business Name): ALEXANDREA RIVERA AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28601 CHAGRIN BLVD STE 500
WOODMERE OH
44122-4562
US

IV. Provider business mailing address

28601 CHAGRIN BLVD STE 500
WOODMERE OH
44122-4562
US

V. Phone/Fax

Practice location:
  • Phone: 216-561-0312
  • Fax:
Mailing address:
  • Phone: 216-561-0312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number2023151367
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: