| NPI | 1174349104 |
|---|---|
| Former Legal Business Name | REVIVE HEALTHCARE CLINIC LLC |
| Entity Type | Organization |
| Authorized Contact | NAUREEN SALIM Owner 214-777-2703 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2024-11-25 |
| Last Update Date | 2024-11-25 |