| NPI | 1134995426 |
|---|---|
| Doing Business As | REVITALIZE PSYCHIATRIC SERVICES, INC. |
| Entity Type | Organization |
| Authorized Contact | KELLY LYNN HUFFMAN CEO 815-212-1478 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2023-11-28 |
| Last Update Date | 2023-11-28 |