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NPI Code Detail

MEDICARE: LISA DENISE RIVERA FNP

MEDICARE: LISA DENISE RIVERA FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerF337867-1NY
2363LP0808XPsychiatric/Mental Health Nurse PractitionerF402533-01NY

General Provider Information

NPI Number : 1093146391
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA DENISE RIVERA FNP
Provider Business Mailing Address
First Line : 30 RED OAK DR
Second Line :
City : WILLIAMSVILLE
State : NY
Zip : 14221-2302
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10 SYMPHONY CIR
Second Line :
City : BUFFALO
State : NY
Zip : 14201-1363
Country : US
Telephone Number : 716-783-3221
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2013
Last Update Date : 06/11/2023

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