Provider Demographics
NPI:1386535003
Name:REVOLLIDO, LEA LALANGAN (RN)
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:LALANGAN
Last Name:REVOLLIDO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 NW 62ND ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-1008
Mailing Address - Country:US
Mailing Address - Phone:503-914-8237
Mailing Address - Fax:360-314-2382
Practice Address - Street 1:1513 NW 62ND ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-1008
Practice Address - Country:US
Practice Address - Phone:503-914-8237
Practice Address - Fax:360-314-2382
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00174442163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty