NPI 1003084369
Jacqueline Revello, MARN
Practice location
- Address
- 11115 W. Hwy 24, Unit 2c, Divide, CO 80814
- Phone
- (719) 687-6416
- Mailing address
- PO Box 214 682 Simba Point, Divide, CO 80814-0214
Registered specialties (2)
Registered Nurse
Primary
Counselor
Registry record
- NPI
- 1003084369
- Entity type
- Individual
- Sex (as registered)
- Female
- NPI issued
- 20 Feb 2008
- Record last updated
- 10 Feb 2017
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.