Provider Demographics
NPI:1861559825
Name:VENEY, REVIA MICHELLE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:REVIA
Middle Name:MICHELLE
Last Name:VENEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17101 ASPEN LEAF DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3643
Mailing Address - Country:US
Mailing Address - Phone:301-464-2169
Mailing Address - Fax:
Practice Address - Street 1:3800 LOTTSFORD VISTA RD
Practice Address - Street 2:SKILLED NURSING FACILITY-
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-4018
Practice Address - Country:US
Practice Address - Phone:301-832-2095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN56198363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0373178Medicaid
DCQ08687Medicare UPIN
DC0373178Medicaid