| NPI | 1548935646 |
|---|---|
| Doing Business As | REVIVE LIFESTYLE MEDICINE |
| Entity Type | Organization |
| Authorized Contact | LINDSEY GILLUM Mng Member 501-779-8554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2021-08-11 |
| Last Update Date | 2022-07-08 |