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General NPI Number Information
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NPI Number | 1780563114
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Entity Type | Individual
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Provider Name | JAMES REVORD RN
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Gender | Male
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Dates
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Enumeration Date | 08/29/2025
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 7171 GLENMEADOW CT
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City | GRAND BLANC
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State | MI
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Zip | 48439-7586
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Country | US
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Telephone | 810-938-0720
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Fax |
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Provider Business Mailing Address
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Address Line | 7171 GLENMEADOW CT
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City | GRAND BLANC
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State | MI
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Zip | 48439-7586
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Country | US
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Telephone | 810-938-0720
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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 | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number | 4704267931
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 163WH1000X
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Taxonomy Name | Hospice Registered Nurse
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License Number | 4704267931
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 163WC1600X
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Taxonomy Name | Continuing Education/Staff Development Registered Nurse
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License Number | 4704267931
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License Number State | MI
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