Provider Demographics
NPI:1972190114
Name:RAVENELL, ANTIONETTE LABARBRA
Entity Type:Individual
Prefix:
First Name:ANTIONETTE
Middle Name:LABARBRA
Last Name:RAVENELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 CLOVER PARK DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-1434
Mailing Address - Country:US
Mailing Address - Phone:817-500-3873
Mailing Address - Fax:817-200-6203
Practice Address - Street 1:2200 CLOVER PARK DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-1434
Practice Address - Country:US
Practice Address - Phone:817-500-3873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty