Provider Demographics
NPI:1346799574
Name:REVELL, HANNAH (FNP-C)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:REVELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 GA HIGHWAY 49 N
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-4042
Mailing Address - Country:US
Mailing Address - Phone:478-956-5002
Mailing Address - Fax:478-956-5003
Practice Address - Street 1:218 GA HIGHWAY 49 N
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-4042
Practice Address - Country:US
Practice Address - Phone:478-956-5002
Practice Address - Fax:478-956-5003
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN231047363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily