Provider Demographics
NPI:1033887476
Name:LEICHTER, RIVKA R (CRNP)
Entity Type:Individual
Prefix:
First Name:RIVKA
Middle Name:R
Last Name:LEICHTER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6809 CHIPPEWA DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1434
Mailing Address - Country:US
Mailing Address - Phone:410-484-8355
Mailing Address - Fax:
Practice Address - Street 1:10710 CHARTER DR STE G030
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3261
Practice Address - Country:US
Practice Address - Phone:443-546-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR185521363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner