Provider Demographics
NPI:1952424418
Name:RIVERA, DORIS MARIE (RN,NNP-BC)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:MARIE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:RN,NNP-BC
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, NNP-BC
Mailing Address - Street 1:2653 SAN ANDRES DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79763-2331
Mailing Address - Country:US
Mailing Address - Phone:432-334-6124
Mailing Address - Fax:
Practice Address - Street 1:3001 E PRESIDENT GEORGE BUSH HWY STE 250
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3552
Practice Address - Country:US
Practice Address - Phone:432-332-4983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX239552363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX239552OtherNP LICENSE