| NPI | 1790563252 |
|---|---|
| Former Legal Business Name | REVIVE HEALTH & WELLNESS |
| Entity Type | Organization |
| Authorized Contact | JENEA BENNETT-TALLEY Nurse Practitioner 804-636-3918 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2023-09-18 |
| Last Update Date | 2023-09-18 |