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REVIVE WELLNESS AND REJUVENATION LLC
NPI 1184252678
Nurse Practitioner - Family in Glendale, AZ

Active since March 30, 2020
20229 N 67TH AVE STE C-A, GLENDALE, AZ 85308(602) 595-7836 Get Directions Write a Review

NPPES record last updated: May 1, 2020. Verified against the NPPES registry weekly; last sync: November 08, 2026.

About Revive Wellness And Rejuvenation Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

REVIVE WELLNESS AND REJUVENATION LLC (NPI 1184252678) is a healthcare organization registered as a family in Glendale, Arizona and active in the NPI registry since March 2020. The organization lists Robert Graham, President, as its authorized official.

NPPES Registry Identity

NPI1184252678
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameREVIVE WELLNESS AND REJUVENATION LLC
Location Address20229 N 67TH AVE STE C-AGlendale, AZ 85308-6664
Mailing Address20229 N 67th Ave Ste C-aGlendale, AZ 85308-6664 · (602) 595-7836
Phone(602) 595-7836
Organization SubpartNo
Authorized OfficialRobert GrahamPresident · (602) 595-7836
Enumeration DateMarch 30, 2020
Last NPPES UpdateMay 1, 2020
NPPES CertifiedMay 1, 2020
✔ NPI 1184252678 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
20229 N 67TH AVE STE C-A, Glendale, AZ 85308
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Revive Wellness And Rejuvenation LLC's NPI number?

The NPI number for Revive Wellness And Rejuvenation LLC is 1184252678. It was assigned to this organization in the NPPES registry on March 30, 2020.

Where is Revive Wellness And Rejuvenation LLC located?

Revive Wellness And Rejuvenation LLC is located at 20229 N 67th Ave Ste C-A, Glendale, AZ 85308. The listed phone number is (602) 595-7836.

What is Revive Wellness And Rejuvenation LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

When was this NPI record last updated?

The NPPES record for Revive Wellness And Rejuvenation LLC was last updated on May 1, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.