Provider Demographics
NPI:1245631258
Name:BOUNAN, REVA ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:REVA
Middle Name:ANN
Last Name:BOUNAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:201 BACK RIVER NECK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-3949
Mailing Address - Country:US
Mailing Address - Phone:410-887-7182
Mailing Address - Fax:410-887-0243
Practice Address - Street 1:201 BACK RIVER NECK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-3949
Practice Address - Country:US
Practice Address - Phone:410-887-7182
Practice Address - Fax:410-887-0243
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR051082163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator