Healthcare Provider Details

I. General information

NPI: 1629720222
Provider Name (Legal Business Name): EMMA NICOLE REVELANT DNP, CNM, BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 ROEBLING ST
BROOKLYN NY
11211-6204
US

IV. Provider business mailing address

225 E 36TH ST APT 5O
NEW YORK NY
10016-3613
US

V. Phone/Fax

Practice location:
  • Phone: 844-692-4692
  • Fax:
Mailing address:
  • Phone: 516-469-9670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number821414
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberF002439
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: