Provider Demographics
NPI:1558793828
Name:REVELLE, JOHANNAH RUTH (CNIM, R EPT)
Entity Type:Individual
Prefix:MS
First Name:JOHANNAH
Middle Name:RUTH
Last Name:REVELLE
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Gender:F
Credentials:CNIM, R EPT
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Mailing Address - Street 1:25 HIGHLAND PARK VLG
Mailing Address - Street 2:SUITE 100-225
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-2789
Mailing Address - Country:US
Mailing Address - Phone:214-536-1647
Mailing Address - Fax:972-625-2884
Practice Address - Street 1:25 HIGHLAND PARK VLG
Practice Address - Street 2:SUITE 100-225
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-2789
Practice Address - Country:US
Practice Address - Phone:214-536-1647
Practice Address - Fax:972-625-2884
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2015-09-24
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic