Provider Demographics
NPI:1225195480
Name:REVELS, DOLORES C (CRNP)
Entity type:Individual
Prefix:
First Name:DOLORES
Middle Name:C
Last Name:REVELS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:DOLORES
Other - Middle Name:BULL
Other - Last Name:REVELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:525 BRIGHTS LN
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-1141
Mailing Address - Country:US
Mailing Address - Phone:215-872-5968
Mailing Address - Fax:
Practice Address - Street 1:120 VALLEY GREEN LN
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2079
Practice Address - Country:US
Practice Address - Phone:484-476-6230
Practice Address - Fax:484-475-7802
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP002207C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA075727Medicare PIN
Q04492Medicare UPIN