Active NPI
Kathleen Ann Revello, RDH
- Dental Hygienist
- Verona, WI
National Provider Identifier
1669117495
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 4036-16
- Practice address
- 1100 E Verona Ave
Verona, WI 53593-8717 - Phone
- (608) 845-6601
- Fax
- (608) 845-1264
- NPI assigned
- May 5, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 4036-16 | WI | Primary |
Addresses
Primary practice location
1100 E Verona Ave
Verona, WI 53593-8717
Mailing address
1100 E Verona Ave
Verona, WI 53593-8717
Phone (608) 845-6601
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4036-16 | WI | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1651708800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651708800000",
"number": "1669117495",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 E VERONA AVE",
"city": "VERONA",
"state": "WI",
"postal_code": "535938717",
"telephone_number": "608-845-6601",
"fax_number": "608-845-1264"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 E VERONA AVE",
"city": "VERONA",
"state": "WI",
"postal_code": "535938717",
"telephone_number": "608-845-6601",
"fax_number": "608-845-1264"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REVELLO",
"first_name": "KATHLEEN",
"middle_name": "ANN",
"credential": "RDH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-05-05",
"last_updated": "2022-05-05",
"certification_date": "2022-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "WI",
"license": "4036-16",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Verona, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.