Provider Demographics
NPI:1760191837
Name:REVELS, SHOUNTA ROCHALLE (RN)
Entity Type:Individual
Prefix:
First Name:SHOUNTA
Middle Name:ROCHALLE
Last Name:REVELS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHOUNTA
Other - Middle Name:ROCHALLE
Other - Last Name:CANDIES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:6162 S WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-5113
Mailing Address - Country:US
Mailing Address - Phone:303-795-4584
Mailing Address - Fax:
Practice Address - Street 1:6162 S WILLOW DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-5113
Practice Address - Country:US
Practice Address - Phone:303-220-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1674484163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse