MEDICARE: GEANNA REVELL NUTRITION

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	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1659244861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEANNA REVELL NUTRITION

Provider Business Mailing Address
First Line	:	2863 W GOVERNMENT WAY
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98199-1420
Country	:	US
Telephone Number	:	425-610-7689
Fax Number	:

Provider Business Practice Location Address
First Line	:	2863 W GOVERNMENT WAY
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98199-1420
Country	:	US
Telephone Number	:	425-610-7689
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED DIETITIAN/ OWNER
Name	:	GEANNA REVELL
Credential	:	RD
Telephone Number	:	425-610-7689

Provider Enumeration Date	:	09/24/2025
Last Update Date	:	09/24/2025

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