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General NPI Number Information
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NPI Number | 1194117259
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Entity Type | Individual
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Provider Name | SANDRA DEJESUS RIVERA CRNP
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Gender | Female
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Dates
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Enumeration Date | 02/26/2015
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 777 TOWNSHIP LINE ROAD 2ND FLOOR
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City | YARDLEY
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State | PA
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Zip | 19067-5564
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Country | US
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Telephone | 800-789-7366
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Fax | 215-340-3575
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Provider Business Mailing Address
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Address Line | 801 SPRUCE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19107-5701
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Country | US
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Telephone | 800-789-7366
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Fax | 215-340-3575
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP014643
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ15297300
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License Number State | NJ
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