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General NPI Number Information
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NPI Number | 1912477027
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Entity Type | Individual
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Provider Name | LOURDES M RIVERA APRN
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Gender | Female
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Dates
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Enumeration Date | 12/01/2018
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Last Update Date | 03/01/2023
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Provider Practice Location Address
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Address Line | 6480 WATERLOO RD
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City | ELKRIDGE
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State | MD
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Zip | 21075-6508
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Country | US
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Telephone | 410-799-0291
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Fax |
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Provider Business Mailing Address
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Address Line | 9601 PULASKI PARK DR STE 417
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City | BALTIMORE
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State | MD
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Zip | 21220-1409
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Country | US
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Telephone | 410-933-5678
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Fax |
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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 | AC004543
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License Number State | MD
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