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NPI Code Detail

MEDICARE: ELLIE C REVERMAN

MEDICARE: ELLIE C REVERMAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1376499566
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLIE C REVERMAN
Provider Business Mailing Address
First Line : 6855 LYNNFIELD CT
Second Line :
City : CINCINNATI
State : OH
Zip : 45243-1701
Country : US
Telephone Number : 513-313-8123
Fax Number :
Provider Business Practice Location Address
First Line : 5050 MADISON RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45227-1491
Country : US
Telephone Number : 513-272-2800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2026
Last Update Date : 03/09/2026

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Directions to “ ELLIE C REVERMAN ” Practice Location

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