Marna Marie Revlock, APRN

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

APRN.CNP.0029897 Issued in OH

Practice address

128 Wertz Ave NW Ste a
Canton, OH 44708-4196

Phone

(330) 936-6863

NPI assigned

Nov 15, 2021

Last updated

Nov 15, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northeast Ohio Foot and Ankle Specialists LLC

  dba Luckino Foot & Ankle Associates

  • Foot & Ankle Surgery Podiatrist
  • Canton, OH
  • NPI 1922527118
  Medicare reassignment NPD
• Vitality Med LLC

  dba Vitality Med

  • Health Service Clinic/Center
  • Canton, OH
  • NPI 1881352854
  Authorized official Same address or phone

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

{
    "created_epoch": "1636934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636934400000",
    "number": "1407512304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2210 UNIVERSITY DR SE",
            "city": "MASSILLON",
            "state": "OH",
            "postal_code": "446467443",
            "telephone_number": "330-936-6863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 WERTZ AVE NW STE A",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447084196",
            "telephone_number": "330-936-6863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVLOCK",
        "first_name": "MARNA",
        "middle_name": "MARIE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-15",
        "last_updated": "2021-11-15",
        "certification_date": "2021-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OH",
            "license": "APRN.CNP.0029897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Restoration Community Services LLC
• Restoring Hope Counseling Services LLC (Tonya Watts)
• Restoring Hope Counseling Services LLC (Tonya Watts)
• Emily Reusser, D.D.S.
• Revive Hair & Nail Solutions LLC (Lisas Creative Hair Replacement Studio)
• Rex Transport, Inc.
• Bianca Reyes, MFT
• Rachel Reyna, RN
• Emani L Reynolds
• Erin Reynolds

• Adult Health Nurse Practitioner in Canton, OH
• Providers in Canton, OH by specialty
• Adult Health Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.