Healthcare Provider Details

I. General information

NPI: 1558769901
Provider Name (Legal Business Name): LAURA REVIERE WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2014
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7020 BERRY FARMS XING STE 100
FRANKLIN TN
37064-7003
US

IV. Provider business mailing address

2103 MORTON DR
SPRING HILL TN
37174-1576
US

V. Phone/Fax

Practice location:
  • Phone: 629-230-9252
  • Fax:
Mailing address:
  • Phone: 615-430-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN0000165254
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAPN0000019592
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPN0000019592
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: