Healthcare Provider Details

I. General information

NPI: 1891443743
Provider Name (Legal Business Name): COURTNEY NIKOLE RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PLANTATION PARK DR STE 108
BLUFFTON SC
29910-6033
US

IV. Provider business mailing address

580 HOWARD AVE
SOMERSET NJ
08873-1113
US

V. Phone/Fax

Practice location:
  • Phone: 843-706-2933
  • Fax: 888-977-1514
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAS-0825
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: