| NPI | 1548785801 |
|---|---|
| Doing Business As | RENEWED VITALITY |
| Entity Type | Organization |
| Authorized Contact | GREGORY C BOLTON Md/Owner 484-516-2937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology |
| Additional Taxonomies | 363LX0001X Nurse Practitioner, Obstetrics & Gynecology |
| Enumeration Date | 2017-08-08 |
| Last Update Date | 2022-07-21 |