Individual
DR. BONNIE CAUKINS REVELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
601 CHILDRENS LN, NORFOLK, VA 23507-1910
(757) 668-7456
(757) 668-9255
Mailing address
811 REDGATE AVE, NORFOLK, VA 23507-1515
(757) 668-7007
(757) 668-8658
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
0101240729
VA
208000000X
Pediatrics Physician
27288
NC
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
0101240729
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
71295
BLUE CROSS BLUE SHIELD
NC
05
—
890160M
—
NC
05
—
8971295
—
NC
Enumeration date
05/08/2006
Last updated
05/14/2020
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