Individual
RONELLE REVILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1100 9TH AVE, SEATTLE, WA 98101-2756
(206) 341-0394
Mailing address
1100 9TH AVE, M4-PFS, SEATTLE, WA 98101-2756
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN60560871
WA
363L00000X
Nurse Practitioner
Primary
AP61065135
WA
Other
Enumeration date
03/04/2020
Last updated
10/08/2020
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