Provider Demographics
NPI:1447810973
Name:VIVIANO, ASHLEY C (MSN, APRN, PNP-PC)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:C
Last Name:VIVIANO
Suffix:
Gender:F
Credentials:MSN, APRN, PNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 TALLGRASS CIR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-6730
Mailing Address - Country:US
Mailing Address - Phone:318-286-8684
Mailing Address - Fax:
Practice Address - Street 1:1919 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4436
Practice Address - Country:US
Practice Address - Phone:318-828-2210
Practice Address - Fax:318-828-2215
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP206206363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics