Provider Demographics
NPI:1023358686
Name:REVELS, MARGARET (LPN)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:REVELS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:ANGELA
Other - Last Name:TILLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:515 CLANTON RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-1309
Mailing Address - Country:US
Mailing Address - Phone:704-332-9001
Mailing Address - Fax:704-714-1182
Practice Address - Street 1:549 COX RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0628
Practice Address - Country:US
Practice Address - Phone:707-865-1558
Practice Address - Fax:704-865-9908
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC49702164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse