NPI | 1306276936 |
---|---|
Former Name | SARA B REVELLA |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 23300) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 757303) |
Enumeration Date | 2013-11-18 |
Last Update Date | 2014-02-05 |