| Doctor Name: | MRS. REVA ANN BOUNAN |
| NPI Number: | 1245631258 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | R051082 |
| Business Practice Address: | 201 Back River Neck Rd Suite 100 Essex, MD - 212213949 |
| Business Phone Number: | 4108877182 |
| Business Fax Number: | 4108870243 |
| Mailing Address: | 201 Back River Neck Rd, Suite 100 ESSEX |
| State: | MD |
| Postal Code: | 212213949 |
| Phone Number: | 4108877182 |
| Fax Number: | 4108870243 |
| NPI Enumeration Date: | 09/09/2014 |
| NPI Last Update Date: | 09/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WA2000X |
| License Number: | R051082 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Administrator |
| Taxonomy Definition: | |