Provider Demographics
NPI:1144859562
Name:RIVERA, HENRY
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 RUGER WAY STE 3C
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-2120
Mailing Address - Country:US
Mailing Address - Phone:786-372-2001
Mailing Address - Fax:
Practice Address - Street 1:394 BAR HARBOR RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:ME
Practice Address - Zip Code:04605-5807
Practice Address - Country:US
Practice Address - Phone:207-667-5899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP201155363LF0000X
FLAPRN11005577363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily