MEDICARE: MS. ANDREA MARIE RIVERA FNP-C

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	AP129267	TX

General Provider Information

NPI Number	:	1548633233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANDREA MARIE RIVERA FNP-C

Provider Business Mailing Address
First Line	:	1325 OLD RED RANCH RD
Second Line	:
City	:	DRIPPING SPRINGS
State	:	TX
Zip	:	78620-4630
Country	:	US
Telephone Number	:	512-422-6454
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 OLD RED RANCH RD
Second Line	:
City	:	DRIPPING SPRINGS
State	:	TX
Zip	:	78620-4630
Country	:	US
Telephone Number	:	512-422-6454
Fax Number	:

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

Provider Enumeration Date	:	11/04/2015
Last Update Date	:	09/09/2016

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