Healthcare Provider Details

I. General information

NPI: 1639964869
Provider Name (Legal Business Name): ROSSANGELICA RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR STE 8600
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

600 GRESHAM DR STE 8600
NORFOLK VA
23507-1904
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-6005
  • Fax: 757-388-6006
Mailing address:
  • Phone: 757-388-6005
  • Fax: 757-388-6006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024193182
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: