Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | AP138400 | TX |
Y | 363LG0600X | Nurse Practitioner - Gerontology | AP138400 | TX |
NPI | 1053977892 |
---|---|
Provider Name | Itzel Rivera |
First Address | El Paso, TX 79911 |
Second Address | El Paso, TX 79911 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2019 |
Last Update Date | 26/05/2021 |