Individual
RENE L. REVELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
304A E 4TH ST, ELDON, MO 65026-1808
(573) 557-2400
(573) 557-2401
Mailing address
PO BOX 1500, OSAGE BEACH, MO 65065-1500
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2015010647
MO
363LF0000X
Family Nurse Practitioner
COA15919NP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0105747
—
OH
05
—
3810027971
—
WV
Enumeration date
06/24/2014
Last updated
06/29/2015
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