Provider Demographics
NPI:1891853123
Name:RIVERA, ADRIANA (CNM)
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:ADRIANA
Other - Middle Name:
Other - Last Name:MERCADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:3229 W 47TH PL STE 200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-3011
Mailing Address - Country:US
Mailing Address - Phone:773-254-6044
Mailing Address - Fax:312-526-2368
Practice Address - Street 1:3229 W 47TH PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-3011
Practice Address - Country:US
Practice Address - Phone:773-254-6044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-004862367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209-004862OtherAPN STATE LICENSE
367830Medicare PIN