Provider Demographics
NPI:1174981799
Name:RIVERA-HERRERA, DUMAR (APN, CRNA)
Entity type:Individual
Prefix:MR
First Name:DUMAR
Middle Name:
Last Name:RIVERA-HERRERA
Suffix:
Gender:M
Credentials:APN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-4905
Mailing Address - Country:US
Mailing Address - Phone:862-812-9020
Mailing Address - Fax:
Practice Address - Street 1:25 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-4905
Practice Address - Country:US
Practice Address - Phone:862-812-9020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2019-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR14881000163W00000X
NJ26NJ00629400367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse