Individual
LISA REVELS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
144 DIVISION ST, NEPTUNE, NJ 07753-5043
(732) 233-9880
Mailing address
144 DIVISION ST, NEPTUNE, NJ 07753-5043
(732) 233-9880
Taxonomy
Speciality
Code
Description
License number
State
374J00000X
Doula
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
374J00000X
—
NJ
Enumeration date
11/09/2022
Last updated
11/09/2022
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