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General NPI Number Information
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NPI Number | 1548645534
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Entity Type | Individual
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Provider Name | ROBERT SHAUN REVELS CRNA
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Gender | Male
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Dates
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Enumeration Date | 07/20/2015
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 342 FAIRVIEW ST
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City | SILVERTON
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State | OR
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Zip | 97381-1917
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Country | US
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Telephone | 503-873-1500
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Fax |
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Provider Business Mailing Address
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Address Line | LANDSTUHL REGIONAL MEDICAL CENTER UNIT 33100
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City | APO
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State | AE
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Zip | 09180-3100
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Country | US
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Telephone | 314-590-7028
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 2021037326
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | N360586299
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 10025383
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License Number State | OR
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