Provider Demographics
NPI:1568899342
Name:VIVERETTE, ERICA WYVONNE
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:WYVONNE
Last Name:VIVERETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34290 FORD RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-3051
Mailing Address - Country:US
Mailing Address - Phone:585-415-7104
Mailing Address - Fax:
Practice Address - Street 1:34290 FORD RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-3051
Practice Address - Country:US
Practice Address - Phone:585-415-7104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-11
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704362102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse