Provider Demographics
NPI:1205254752
Name:RIVERS, LAURETTE ELIZABETH (APRN, CPNP-PC, CLC)
Entity type:Individual
Prefix:MRS
First Name:LAURETTE
Middle Name:ELIZABETH
Last Name:RIVERS
Suffix:
Gender:F
Credentials:APRN, CPNP-PC, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 NE LAWRIE TATUM RD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-3002
Mailing Address - Country:US
Mailing Address - Phone:580-354-5500
Mailing Address - Fax:580-354-5511
Practice Address - Street 1:1515 NE LAWRIE TATUM RD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507-3002
Practice Address - Country:US
Practice Address - Phone:580-354-5500
Practice Address - Fax:580-354-5511
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK92722163W00000X
HI85067163W00000X
HI2275363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse