| 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 |