Healthcare Provider Details

I. General information

NPI: 1952424418
Provider Name (Legal Business Name): DORIS MARIE RIVERA RN,NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIE RIVERA RN, NNP-BC

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 E PRESIDENT GEORGE BUSH HWY STE 250
RICHARDSON TX
75082-3552
US

IV. Provider business mailing address

2653 SAN ANDRES DR
ODESSA TX
79763-2331
US

V. Phone/Fax

Practice location:
  • Phone: 432-332-4983
  • Fax:
Mailing address:
  • Phone: 432-334-6124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number239552
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: