Healthcare Provider Details

I. General information

NPI: 1609516038
Provider Name (Legal Business Name): BETSY REVERS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E 5TH AVE
ANTIGO WI
54409-2710
US

IV. Provider business mailing address

N5352 COUNTY ROAD V
BRYANT WI
54418-9790
US

V. Phone/Fax

Practice location:
  • Phone: 715-623-2351
  • Fax:
Mailing address:
  • Phone: 414-388-0535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8163221
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: