Provider Demographics
NPI:1386025252
Name:RIVERA, ERICA NICOLE (RN)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:NICOLE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 FRANKLIN CT
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-1900
Mailing Address - Country:US
Mailing Address - Phone:631-394-8214
Mailing Address - Fax:
Practice Address - Street 1:14 FRANKLIN CT
Practice Address - Street 2:
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950-1900
Practice Address - Country:US
Practice Address - Phone:631-394-8214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY776875163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse