Provider Demographics
NPI:1871259242
Name:RIVERA, ANGELICA M (MS, AGACNP-BC)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:M
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MS, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 VIRGINIA RD APT 3D
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-1408
Mailing Address - Country:US
Mailing Address - Phone:914-473-8538
Mailing Address - Fax:
Practice Address - Street 1:70 VIRGINIA RD APT 3D
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-1408
Practice Address - Country:US
Practice Address - Phone:914-473-8538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY431593363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care