Provider Demographics
NPI:1629704267
Name:REVELLI, CHRYSTINE RAE (FNP-C)
Entity Type:Individual
Prefix:
First Name:CHRYSTINE
Middle Name:RAE
Last Name:REVELLI
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 1:7675 MISSION VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4429
Mailing Address - Country:US
Mailing Address - Phone:800-316-6314
Mailing Address - Fax:
Practice Address - Street 1:7675 MISSION VALLEY RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4429
Practice Address - Country:US
Practice Address - Phone:800-316-6314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV857570363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner