Individual
STEPHANIE R REVORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
201 RIDGE ST STE 312, COUNCIL BLUFFS, IA 51503-4643
(712) 396-7880
(712) 396-7885
Mailing address
PO BOX 3755, OMAHA, NE 68103-0755
(402) 354-2100
(402) 354-2155
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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