Individual
MARY REVILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10700 CHURCHILL AVE, CLEVELAND, OH 44106-1209
(216) 791-2496
Mailing address
10700 CHURCHILL AVE, CLEVELAND, OH 44106-1209
(216) 791-2496
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
166851
OH
Other
Enumeration date
05/01/2014
Last updated
05/01/2014
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