Provider Demographics
NPI:1396980314
Name:RIVERA, RITA C (APRN, FNP, BSN)
Entity type:Individual
Prefix:MS
First Name:RITA
Middle Name:C
Last Name:RIVERA
Suffix:
Gender:F
Credentials:APRN, FNP, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 E MOUNTAIN VIEW RD
Mailing Address - Street 2:STE 220
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5172
Mailing Address - Country:US
Mailing Address - Phone:203-237-2229
Mailing Address - Fax:
Practice Address - Street 1:220 COE AVE
Practice Address - Street 2:PLATT HIGH SCHOOL SBHC
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-3913
Practice Address - Country:US
Practice Address - Phone:203-237-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003908363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004236346Medicaid