Provider Demographics
NPI:1821575747
Name:RIVERA, YURI (RN)
Entity Type:Individual
Prefix:
First Name:YURI
Middle Name:
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:PO BOX 3508
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-8189
Mailing Address - Country:US
Mailing Address - Phone:844-267-5437
Mailing Address - Fax:844-543-7329
Practice Address - Street 1:110 E LOUISIANA
Practice Address - Street 2:SUITE 201-AMP
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069
Practice Address - Country:US
Practice Address - Phone:844-267-5437
Practice Address - Fax:844-543-7329
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX794134163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX345177501Medicaid