Provider Demographics
NPI:1548424997
Name:RIVERA, MARIA OLIVA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:OLIVA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:O
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:PO BOX 352
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10535-0352
Mailing Address - Country:US
Mailing Address - Phone:914-523-7711
Mailing Address - Fax:845-603-6013
Practice Address - Street 1:16 TAURAT PL
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-5108
Practice Address - Country:US
Practice Address - Phone:845-526-2204
Practice Address - Fax:845-603-6013
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301202364SP0808X
NYF331014363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health