Healthcare Provider Details

I. General information

NPI: 1063046126
Provider Name (Legal Business Name): JANIA REVELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 CHARLOTTE AVE
NASHVILLE TN
37209-4129
US

IV. Provider business mailing address

2500 CHARLOTTE AVE
NASHVILLE TN
37209-4129
US

V. Phone/Fax

Practice location:
  • Phone: 615-340-5616
  • Fax:
Mailing address:
  • Phone: 615-340-5616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number222360
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: