Healthcare Provider Details

I. General information

NPI: 1528915576
Provider Name (Legal Business Name): MRS. VIVIENNE REVIERE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28475 GREENFIELD RD STE 113
SOUTHFIELD MI
48076-3034
US

IV. Provider business mailing address

28475 GREENFIELD RD STE 113
SOUTHFIELD MI
48076-3034
US

V. Phone/Fax

Practice location:
  • Phone: 586-690-5391
  • Fax:
Mailing address:
  • Phone: 586-690-5391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704345711
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: