Provider Demographics
NPI:1700922572
Name:RAVELLA, PATRICIA C (CRNP, PHD)
Entity type:Individual
Prefix:MISS
First Name:PATRICIA
Middle Name:C
Last Name:RAVELLA
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Gender:F
Credentials:CRNP, PHD
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Mailing Address - Street 1:10814 HICKORY RIDGE ROAD
Mailing Address - Street 2:DR NADU TUAKLI FAMILY PRACTICE AND ANTI-AGING
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3622
Mailing Address - Country:US
Mailing Address - Phone:410-992-0178
Mailing Address - Fax:410-992-1606
Practice Address - Street 1:10814 HICKORY RIDGE ROAD
Practice Address - Street 2:DR NADU TUAKLI FAMILY PRACTICE AND ANTI-AGING
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3622
Practice Address - Country:US
Practice Address - Phone:410-531-1440
Practice Address - Fax:410-531-1412
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2012-07-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDR138110363LF0000X
MDAC001038FNP363LF0000X
SC17737RNAPRNFNP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD227500700Medicaid
MD227500700Medicaid
MDS69523Medicare UPIN