Healthcare Provider Details

I. General information

NPI: 1801006598
Provider Name (Legal Business Name): HEATHER M. RIVERA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER M. WELSH CRNP

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 OLD LANCASTER AVENUE BRYN MAWR HOSPITAL MOB NORTH, SUITE 203
BRYN MAWR PA
19010
US

IV. Provider business mailing address

280 OLD LANCASTER AVENUE BRYN MAWR HOSPITAL MOB NORTH, SUITE 203
BRYN MAWR PA
19010
US

V. Phone/Fax

Practice location:
  • Phone: 610-527-1600
  • Fax: 610-527-0824
Mailing address:
  • Phone: 610-527-1600
  • Fax: 610-527-0824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License NumberSP008857
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License NumberF430322-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: