Provider Demographics
NPI:1306876073
Name:RIVERA-CORTES, LAURI ELEANOR (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:LAURI
Middle Name:ELEANOR
Last Name:RIVERA-CORTES
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:LAURI
Other - Middle Name:ELEANOR
Other - Last Name:BOLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:138 CIMARRON CRK
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2843
Mailing Address - Country:US
Mailing Address - Phone:248-761-9538
Mailing Address - Fax:
Practice Address - Street 1:4383 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3307
Practice Address - Country:US
Practice Address - Phone:210-593-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139247363LA2100X
MI4704222343363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care