MEDICARE: CHRISTIE MARIE RIVARD

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	363LF0000X	Family Nurse Practitioner	4704242284	MI

General Provider Information

NPI Number	:	1134599509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIE MARIE RIVARD

Provider Business Mailing Address
First Line	:	57403 BRECKENRIDGE DR
Second Line	:
City	:	WASHINGTON TWP
State	:	MI
Zip	:	48094-3580
Country	:	US
Telephone Number	:	586-924-8845
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 N SQUIRREL RD
Second Line	:
City	:	ROCHESTER
State	:	MI
Zip	:	48309-4402
Country	:	US
Telephone Number	:	248-370-2100
Fax Number	:

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

Provider Enumeration Date	:	09/29/2015
Last Update Date	:	09/29/2015

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Directions to “ CHRISTIE MARIE RIVARD ” Practice Location

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