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Individual
STEPHANIE R REVORD
Active
Individual
STEPHANIE R REVORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
F141666
IA
363LW0102X
Women's Health Nurse Practitioner
F141666
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026211300
—
NE
05
—
10026480117
—
NE
05
—
1174992846
—
IA
Enumeration date
09/23/2015
Last updated
07/03/2019
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