Provider Demographics
NPI:1134620982
Name:REVELY, MONICA
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:REVELY
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 1:312 F ST
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24504-4302
Mailing Address - Country:US
Mailing Address - Phone:434-485-2847
Mailing Address - Fax:
Practice Address - Street 1:312 F ST
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24504-4302
Practice Address - Country:US
Practice Address - Phone:434-485-2847
Practice Address - Fax:434-485-2847
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
347C00000X
VAT60428715347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle