MEDICARE: MONIQUE LAREVIERE

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	363LP2300X	Primary Care Nurse Practitioner	11002669	FL
2	363LF0000X	Family Nurse Practitioner	AP142090	TX

General Provider Information

NPI Number	:	1326607409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIQUE LAREVIERE

Provider Business Mailing Address
First Line	:	4356 EMERALD VIS
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-5384
Country	:	US
Telephone Number	:	561-729-8677
Fax Number	:

Provider Business Practice Location Address
First Line	:	4356 EMERALD VIS
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-5384
Country	:	US
Telephone Number	:	561-729-8677
Fax Number	:

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

Provider Enumeration Date	:	06/11/2019
Last Update Date	:	12/09/2022

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Directions to “ MONIQUE LAREVIERE ” Practice Location

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