Individual
MS. JACQUELINE REVELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, RN
Contact information
Practice address
11115 W. HWY 24, UNIT 2C, DIVIDE, CO 80814
(719) 687-6416
Mailing address
PO BOX 214, 682 SIMBA POINT, DIVIDE, CO 80814-0214
(719) 687-4224
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
163W00000X
Registered Nurse
Primary
RN0188325
CO
Other
Enumeration date
02/20/2008
Last updated
02/10/2017
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