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 |