Individual
GLEN P REVERE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.D., C.D.E.
Contact information
Practice address
12033 AGENCY RD, PARKER, AZ 85344-7718
(928) 669-2137
(928) 669-3131
Mailing address
12033 AGENCY RD, PARKER, AZ 85344-7718
(928) 669-2137
(928) 669-3131
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
473669
—
Other
Enumeration date
11/21/2006
Last updated
07/08/2007
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