MEDICARE: MRS. LAURIE EILEEN BIVINS RN, MSN, CPNP

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	163W00000X	Registered Nurse	094302	GA
2	363LP0200X	Pediatric Nurse Practitioner	85069	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417932567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURIE EILEEN BIVINS RN, MSN, CPNP

Provider Business Mailing Address
First Line	:	3515 DALLAS HWY SW STE C
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-2095
Country	:	US
Telephone Number	:	770-943-9150
Fax Number	:	770-218-0278

Provider Business Practice Location Address
First Line	:	3515 DALLAS HWY SW STE C
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-2095
Country	:	US
Telephone Number	:	770-943-9150
Fax Number	:	770-218-0278

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

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	12/04/2025

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