Provider Demographics
NPI:1689492621
Name:RIVAL, DANIEL (AGNP-C)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:RIVAL
Suffix:
Gender:M
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 LANTANA DR
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-8807
Mailing Address - Country:US
Mailing Address - Phone:027-633-4553
Mailing Address - Fax:302-234-1285
Practice Address - Street 1:304 LANTANA DR
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-8807
Practice Address - Country:US
Practice Address - Phone:027-633-4553
Practice Address - Fax:302-234-1285
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELP-0010825363LP2300X
PASP030338363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health