Individual
SANDRA REVAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
239 HURFFVILLE CROSSKEYS RD, SUITE 160, SEWELL, NJ 08080-4002
(856) 341-8200
(856) 341-8212
Mailing address
239 HURFFVILLE CROSSKEYS RD STE 160, SEWELL, NJ 08080-4005
(856) 341-8200
(856) 341-8215
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
26NR15492200
NJ
363L00000X
Nurse Practitioner
Primary
26NJ00629600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0569313
—
NJ
Enumeration date
12/30/2015
Last updated
01/06/2025
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