Provider Demographics
NPI:1801006598
Name:RIVERA, HEATHER M (CRNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:RIVERA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:M
Other - Last Name:WELSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:280 OLD LANCASTER AVENUE
Mailing Address - Street 2:BRYN MAWR HOSPITAL MOB NORTH, SUITE 203
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010
Mailing Address - Country:US
Mailing Address - Phone:610-527-1600
Mailing Address - Fax:610-527-0824
Practice Address - Street 1:280 OLD LANCASTER AVENUE
Practice Address - Street 2:BRYN MAWR HOSPITAL MOB NORTH, SUITE 203
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010
Practice Address - Country:US
Practice Address - Phone:610-527-1600
Practice Address - Fax:610-527-0824
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008857364SA2100X
NYF430322-1364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA440771OtherMLHC MEDICARE AA #
PA1922077643OtherMLHC GROUP NPI
PA440771OtherMLHC MEDICARE AA #