Provider Demographics
NPI:1891453684
Name:RVLWF MICHIGAN PLLC
Entity Type:Organization
Organization Name:RVLWF MICHIGAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN CRNA
Authorized Official - Phone:865-392-6262
Mailing Address - Street 1:10608 FLICKENGER LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3485
Mailing Address - Country:US
Mailing Address - Phone:865-392-6262
Mailing Address - Fax:865-674-5089
Practice Address - Street 1:42450 W 12 MILE RD STE 105
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-3011
Practice Address - Country:US
Practice Address - Phone:248-970-1340
Practice Address - Fax:833-673-0185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-30
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy