MEDICARE: CARRIE REVILLE C.N.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	APRN 2823	SC

General Provider Information

NPI Number	:	1609993369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE REVILLE C.N.M.

Provider Business Mailing Address
First Line	:	9291 MEDICAL PLAZA DR
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9126
Country	:	US
Telephone Number	:	843-797-3664
Fax Number	:

Provider Business Practice Location Address
First Line	:	9291 MEDICAL PLAZA DR
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9126
Country	:	US
Telephone Number	:	843-797-3664
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/29/2010

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