MEDICARE: RIVKA BORTZ CRNP

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
1	363LF0000X	Family Nurse Practitioner	R192057	MD

General Provider Information

NPI Number	:	1437708286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RIVKA BORTZ CRNP

Provider Business Mailing Address
First Line	:	2403 SYLVALE RD APT C
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21209-1556
Country	:	US
Telephone Number	:	443-452-9950
Fax Number	:

Provider Business Practice Location Address
First Line	:	6503 PARK HEIGHTS AVE APT 2L
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21215-3013
Country	:	US
Telephone Number	:	410-358-2397
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2019
Last Update Date	:	09/04/2019

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