NPIMap

Organization Active NPI

Revelations RX PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Naperville, IL
National Provider Identifier
1265124846
Registry record updated Nov 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
REVELATIONS RX PLLC
Practice address
640 N River Rd Ste 108
Naperville, IL 60563-8947
Phone
(630) 858-0875
NPI assigned
May 23, 2023
Last updated
Nov 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Doris Van ByssumNPI 1063515369
Title
Member/Owner
Phone
(630) 858-0875

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU Primary

Addresses

Primary practice location

640 N River Rd Ste 108
Naperville, IL 60563-8947

Mailing address

174 S Montclair Ave
Glen Ellyn, IL 60137-6357
Phone (630) 858-0875

National Provider Directory

National Provider Directory

Locations

640 N River Rd
Ste 108
Naperville, IL 60563
Phone (630) 359-8951

Practitioners & affiliated clinicians

Practitioners 52

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 52

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1684800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699315200000",
    "number": "1265124846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "174 S MONTCLAIR AVE",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601376357",
            "telephone_number": "630-858-0875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 N RIVER RD STE 108",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605638947",
            "telephone_number": "630-858-0875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVELATIONS RX PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-23",
        "last_updated": "2023-11-07",
        "certification_date": "2023-11-07",
        "status": "A",
        "authorized_official_last_name": "VAN BYSSUM",
        "authorized_official_first_name": "DORIS",
        "authorized_official_title_or_position": "MEMBER/OWNER",
        "authorized_official_telephone_number": "630-858-0875"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Naperville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.