Individual
VALERIE REVOLUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
327 BEACH 19TH ST, FAR ROCKAWAY, NY 11691-4423
(718) 869-7397
Mailing address
37 E 28TH ST RM 508, NEW YORK, NY 10016-7919
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
694186
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
403408
NY
Other
Enumeration date
10/09/2020
Last updated
02/17/2021
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