Healthcare Provider Details

I. General information

NPI: 1487166930
Provider Name (Legal Business Name): DR. CAROLINE REVELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3643 N ROXBORO ST
DURHAM NC
27704
US

IV. Provider business mailing address

4096 FAULKNER LN
TALLAHASSEE FL
32311-1676
US

V. Phone/Fax

Practice location:
  • Phone: 919-479-6193
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number266819
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11008232
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: