Individual
SARA REVELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
900 W NIFONG STE 101, COLUMBIA, MO 65203-3032
(573) 499-9009
(573) 499-4400
Mailing address
670 MASON RIDGE CENTER DR, STE 300, SAINT LOUIS, MO 63141-8573
(573) 499-9009
(573) 499-4400
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
096829
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
096829
STATE LICENSE
MO
Enumeration date
10/27/2006
Last updated
01/26/2016
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