Provider Demographics
NPI:1205995529
Name:RIVERA, WILLIAM CARL (CRNA)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CARL
Last Name:RIVERA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CHADDARIN LN
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-4400
Mailing Address - Country:US
Mailing Address - Phone:202-441-7512
Mailing Address - Fax:
Practice Address - Street 1:116 LANGLEY PKWY
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7521
Practice Address - Country:US
Practice Address - Phone:603-228-7211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2023-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN59997367500000X
MDR115089367500000X
VA0024165528367500000X
NH084359-23367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409194900Medicaid
MD409194900Medicaid
MDP27965Medicare UPIN