Provider Demographics
NPI:1447528518
Name:HETHCOX, ELEANOR RIVERA (NP)
Entity type:Individual
Prefix:MRS
First Name:ELEANOR
Middle Name:RIVERA
Last Name:HETHCOX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:ELEANOR
Other - Middle Name:RIVERA
Other - Last Name:BELEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1372 MESSINA CT
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3270
Mailing Address - Country:US
Mailing Address - Phone:409-256-3996
Mailing Address - Fax:
Practice Address - Street 1:1372 MESSINA CT
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3270
Practice Address - Country:US
Practice Address - Phone:409-256-3996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP121195363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX385132ZSJ1Medicare UPIN