Provider Demographics
NPI:1659244861
Name:GEANNA REVELL NUTRITION
Entity type:Organization
Organization Name:GEANNA REVELL NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:REVELL
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:425-610-7689
Mailing Address - Street 1:2863 W GOVERNMENT WAY
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-1420
Mailing Address - Country:US
Mailing Address - Phone:425-610-7689
Mailing Address - Fax:
Practice Address - Street 1:2863 W GOVERNMENT WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199-1420
Practice Address - Country:US
Practice Address - Phone:425-610-7689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty