REVIVE WELLNESS AND REJUVENATION LLC (NPI# 1184252678) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184252678 |
| Entity Type | Organization |
| Organization Name | REVIVE WELLNESS AND REJUVENATION LLC |
| Practice Address |
20229 N 67th Ave Ste C-a Glendale AZ 85308-6664 |
| Practice Telephone | 6025957836 |
| Mailing Telephone | 6025957836 |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2020-05-01 |
| Authorized Official Name | ROBERT GRAHAM (PRESIDENT) |
| Authorized Official Telephone | 6025957836 |
| Authorized Official Credential | DC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
20229 N 67TH AVE STE C-A |
| City | GLENDALE |
| State | AZ |
| Zip Code | 85308-6664 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972102572 | Inspire Wellness and Pelvic Health | Clinic/Center | 5940 W Union Hills Dr Ste D280, Glendale, AZ 85308 | 2020-10-23 |
| 1669081709 | Michelle Yoakim | Student in an Organized Health Care Education/Training Program | 19555 N 59th Avenuue, Glendale, AZ 85308 | 2020-07-24 |
| 1033742291 | Kaitlyn Marie Shannon | Dietitian, Registered | 20325 North 51st Avenue, Building 9, Suite 166, Glendale, AZ 85308 | 2020-02-17 |
| 1295377687 | Serenity Preserved Counseling Pllc | Counselor | 21448 N. 75th Avenue Ste G, Glendale, AZ 85308 | 2019-10-17 |
| 1013567023 | Caitlyn Heredia | Student in an Organized Health Care Education/Training Program | 18330 N 79th Avenue, Apartment 1070, Glendale, AZ 85308 | 2019-09-12 |
| 1770141061 | Sydney Dangelo | Student in an Organized Health Care Education/Training Program | 7454 W Denaro Dr, Glendale, AZ 85308 | 2019-05-31 |
| 1023585742 | Center for Couples Therapy, Pllc | Counselor | 18205 N 51st Ave, Ste 113, Glendale, AZ 85308 | 2018-10-31 |
| 1831678341 | Ayat Mahdi Obeidi | Dentist | 19420 N 59th Ave Ste D400, Glendale, AZ 85308 | 2018-08-07 |
| 1720580038 | Lifeline Professional Counseling Services, Inc | Clinic/Center | 17235 N 75th Ave Suite F-100, Glendale, AZ 85308 | 2018-03-02 |
| 1003318585 | Danna Mavis Constance Moisii | Physician Assistant | 18301 N. 79th Ave #g190, Glendale, AZ 85308 | 2018-03-01 |
| Find all providers in zip 85308 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770199481 | Steven Cleo Northern Jr. | Nurse Practitioner | 5820 W Greenway Rd Ste 124, Glendale, AZ 85306-3308 | 2020-09-17 |
| 1609493279 | Traci Marie Miramontes | Nurse Practitioner | 6001 W Northview Ave, Glendale, AZ 85301-1857 | 2020-06-30 |
| 1669097697 | Swazi Cromwell | Nurse Practitioner | 13408 N 53rd Ave, Glendale, AZ 85304-1378 | 2020-06-16 |
| 1922620590 | Bethany E Mainville | Nurse Practitioner | 8151 W Sierra Vista Dr, Glendale, AZ 85303-3217 | 2020-05-17 |
| 1083247316 | Anna Lazzaro | Nurse Practitioner | 4760 W Ponderosa Ln, Glendale, AZ 85308-4872 | 2020-02-14 |
| 1760021422 | Judy Fong | Nurse Practitioner | 5220 W Dahlia Dr, Glendale, AZ 85304-1931 | 2019-12-29 |
| 1588207138 | Kristen Mitchell | Nurse Practitioner | 6922 W Kristal Way, Glendale, AZ 85308-5772 | 2019-10-25 |
| 1760038335 | Adrineh Kalantar Ohanian | Nurse Practitioner | 1139 E Lexington Dr, Glendale, CA 91206-3861 | 2019-08-09 |
| 1457904252 | Debra Goldman | Nurse Practitioner | 20325 N 51st Ave # 8, Glendale, AZ 85308-5674 | 2019-07-20 |
| 1821641184 | Haidee Chavez Waymire | Nurse Practitioner | 6710 W Camelback Rd # A, Glendale, AZ 85303-6307 | 2019-07-16 |
| Find all providers in GLENDALE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.