| Doctor Name: | GLEN P REVERE |
| NPI Number: | 1477628980 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | R.D., C.D.E. |
| License Number: | 473669 |
| Business Practice Address: | 12033 Agency Rd Parker, AZ - 853447718 |
| Business Phone Number: | 9286692137 |
| Business Fax Number: | 9286693131 |
| Mailing Address: | 12033 Agency Rd, PARKER |
| State: | AZ |
| Postal Code: | 853447718 |
| Phone Number: | 9286692137 |
| Fax Number: | 9286693131 |
| NPI Enumeration Date: | 11/21/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | 473669 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |