Individual
DONICA REVERE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2059 TORREDGE RD, DURHAM, NC 27712-1767
(919) 477-4474
Mailing address
1512 ECHO RD, DURHAM, NC 27707-1506
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
8093
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8093
SLP LICENSE
NC
Enumeration date
09/15/2008
Last updated
09/15/2008
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