Provider Demographics
NPI:1669345955
Name:REVERON BATULE, NICOHL MICHELLE
Entity type:Individual
Prefix:MISS
First Name:NICOHL
Middle Name:MICHELLE
Last Name:REVERON BATULE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 CALLE HERNANDEZ
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-4438
Mailing Address - Country:US
Mailing Address - Phone:787-599-1198
Mailing Address - Fax:
Practice Address - Street 1:721 CALLE HERNANDEZ
Practice Address - Street 2:MIRAMAR TOWERS APT 2N
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-4438
Practice Address - Country:US
Practice Address - Phone:787-599-1198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR014549171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter