MEDICARE: DR. EMMA NICOLE REVELANT DNP, CNM, BSN, RN

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
1	163W00000X	Registered Nurse	821414	NY
2	176B00000X	Midwife	F002439	NY

General Provider Information

NPI Number	:	1629720222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMMA NICOLE REVELANT DNP, CNM, BSN, RN

Provider Business Mailing Address
First Line	:	225 E 36TH ST APT 5O
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-3613
Country	:	US
Telephone Number	:	516-469-9670
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 ROEBLING ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-6204
Country	:	US
Telephone Number	:	844-692-4692
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2022
Last Update Date	:	02/23/2026

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