Individual
EMILY A REVENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
6600 W BROAD ST STE 300, RICHMOND, VA 23230-1710
(804) 320-4243
(804) 622-0552
Mailing address
1000 BOULDERS PKWY, SUITE 102, RICHMOND, VA 23225-5545
(804) 320-4243
(804) 622-0552
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110002789
VA
363AM0700X
Medical Physician Assistant
Primary
0110002789
VA
Other
Enumeration date
06/10/2008
Last updated
05/20/2021
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