Provider Demographics
NPI:1932546447
Name:VRANA, REVA MIN (NP)
Entity Type:Individual
Prefix:
First Name:REVA
Middle Name:MIN
Last Name:VRANA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:REVA
Other - Middle Name:MIN
Other - Last Name:VRANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:2006 STEFON CT SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2185
Mailing Address - Country:US
Mailing Address - Phone:415-370-1692
Mailing Address - Fax:
Practice Address - Street 1:182 SW ACADEMY ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-1996
Practice Address - Country:US
Practice Address - Phone:503-623-9289
Practice Address - Fax:503-623-7560
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA801962163W00000X
CA23519363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse