MEDICARE: MRS. VIVIENNE REVIERE

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	390200000X	Student in an Organized Health Care Education/Training Program		MI
2	163W00000X	Registered Nurse	4704345711	MI

General Provider Information

NPI Number	:	1528915576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VIVIENNE REVIERE

Provider Business Mailing Address
First Line	:	7474 FRANKLIN RIDGE LN
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4125
Country	:	US
Telephone Number	:	586-690-5391
Fax Number	:

Provider Business Practice Location Address
First Line	:	7474 FRANKLIN RIDGE LN
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4125
Country	:	US
Telephone Number	:	586-690-5391
Fax Number	:

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

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/11/2026

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