Provider Demographics
NPI:1780563114
Name:REVORD, JAMES (RN)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:REVORD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7171 GLENMEADOW CT
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7586
Mailing Address - Country:US
Mailing Address - Phone:810-938-0720
Mailing Address - Fax:
Practice Address - Street 1:7171 GLENMEADOW CT
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-7586
Practice Address - Country:US
Practice Address - Phone:810-938-0720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704267931163WA2000X, 163WH1000X, 163WC1600X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WH1000XNursing Service ProvidersRegistered NurseHospiceGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator