Provider Demographics
NPI:1053790782
Name:NIVERA, REYNARD (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:MR
First Name:REYNARD
Middle Name:
Last Name:NIVERA
Suffix:
Gender:M
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10043 WHITE MULBERRY DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1781
Mailing Address - Country:US
Mailing Address - Phone:808-306-6937
Mailing Address - Fax:
Practice Address - Street 1:6240 N DURANGO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-3943
Practice Address - Country:US
Practice Address - Phone:954-923-7440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-1830363LF0000X
NV826829363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily