Individual
MRS. STACEY LYNN RIVET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
100 MICHIGAN ST NE, MC 117, GRAND RAPIDS, MI 49503-2560
(616) 267-0118
(616) 267-0090
Mailing address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
(616) 486-6794
(616) 486-6702
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704225948
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0N55170019
MEDICARE PLUS BLUE
MI
01
—
1057817
MCLAREN HEALTH PLAN-MEDICAID
MI
01
—
5008772580
BLUE CROSS BLUE SHIELD
MI
01
—
P00766372
RAILROAD MEDICARE
MI
Enumeration date
08/19/2006
Last updated
02/22/2013
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