Evan Gabriel Revery
Student in an Organized Health Care Education/Training Program in Chicago, IL. Individual provider (NPI-1).
NPI number1124874151
StatusActive
Last updated in NPPESApr 29, 2024
Details
- NPI
- 1124874151
- Entity type
- Individual (NPI-1)
- Name
- Evan Gabriel Revery
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Apr 29, 2024
- Certification date
- Apr 29, 2024
- Last updated
- Apr 29, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
Practice location
600 S Paulina St Ste 403Chicago, IL 60612-3806
Phone 312-943-7100
Mailing address
600 S Paulina St Ste 403Chicago, IL 60612-3806
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