Individual
LINDA D REVANCHE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
19 LEDGEBROOK RD APT 1, MATTAPAN, MA 02126-2748
(857) 251-4008
Mailing address
19 LEDGEBROOK RD APT 1, MATTAPAN, MA 02126-2748
(857) 251-4008
Taxonomy
Speciality
Code
Description
License number
State
163WG0600X
Gerontology Registered Nurse
RN2328268
MA
163WH0200X
Home Health Registered Nurse
Primary
RN2328268
MA
Other
Enumeration date
12/21/2018
Last updated
12/21/2018
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