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General NPI Number Information
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NPI Number | 1881247088
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Entity Type | Individual
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Provider Name | HILARY REVIELLO PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/17/2019
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 1530 8TH AVE
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City | BETHLEHEM
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State | PA
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Zip | 18018-1883
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Country | US
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Telephone | 484-526-6545
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Fax |
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Provider Business Mailing Address
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Address Line | 4188 EISENHOWER DR
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City | BETHLEHEM
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State | PA
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Zip | 18020-8946
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Country | US
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Telephone | 610-554-5884
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9114408
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA060751
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License Number State | PA
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