Provider Demographics
NPI:1669847513
Name:RIVERA, NUPUR RAJESH (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:NUPUR
Middle Name:RAJESH
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15205 GRAVENHURST TER
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-3421
Mailing Address - Country:US
Mailing Address - Phone:703-328-7023
Mailing Address - Fax:
Practice Address - Street 1:26 GRAND CORNER AVE STE A
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-7332
Practice Address - Country:US
Practice Address - Phone:301-545-2148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA253507363LF0000X
MDR246312363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily