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Individual
LAURIN REVERE WHEATON
Active
Individual
LAURIN REVERE WHEATON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ACNP
Taxonomy
Speciality
Code
Description
License number
State
363LC1500X
Community Health Nurse Practitioner
Primary
13815
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1510016
MCC-MEDICAID-TN
TN
05
—
1510016
—
TN
Enumeration date
12/09/2008
Last updated
07/29/2013
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