Provider Demographics
NPI:1114348588
Name:RIVERA, MARY MARGARET (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MARY MARGARET
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 W FRYE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6232
Mailing Address - Country:US
Mailing Address - Phone:480-782-5575
Mailing Address - Fax:480-782-5576
Practice Address - Street 1:1850 W FRYE RD STE 102
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6232
Practice Address - Country:US
Practice Address - Phone:480-782-5575
Practice Address - Fax:480-782-5576
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-02
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5338363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily