Provider Demographics
NPI:1861005837
Name:RIVERA, CLAIR ROSER (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CLAIR
Middle Name:ROSER
Last Name:RIVERA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 S 20TH ST STE 160
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4941
Mailing Address - Country:US
Mailing Address - Phone:414-509-8826
Mailing Address - Fax:414-509-8827
Practice Address - Street 1:3305 S 20TH ST STE 160
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4941
Practice Address - Country:US
Practice Address - Phone:414-509-8826
Practice Address - Fax:414-509-8827
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10282-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily