MEDICARE: LAINEY ELIZABETH BIVIN

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	390200000X	Student in an Organized Health Care Education/Training Program		AR

General Provider Information

NPI Number	:	1700718319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAINEY ELIZABETH BIVIN

Provider Business Mailing Address
First Line	:	4532 STONECREST
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72762-8103
Country	:	US
Telephone Number	:	479-502-3274
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 S 52ND ST
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8637
Country	:	US
Telephone Number	:	877-505-2276
Fax Number	:

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

Provider Enumeration Date	:	05/30/2026
Last Update Date	:	05/30/2026

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Directions to “ LAINEY ELIZABETH BIVIN ” Practice Location

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