| Reviv PLLC | |
|
3029 Brandt Dr S Ste A Fargo ND 58104-9140 | |
| (701) 566-5306 | |
| Not Available |
| Full Name | Reviv PLLC |
|---|---|
| Speciality | General Practice |
| Location | 3029 Brandt Dr S Ste A, Fargo, North Dakota |
| Authorized Official Name and Position | Laura Lisa Job (OPERATIONS MANAGER) |
| Authorized Official Contact | 7015266530 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Reviv PLLC 3029 Brandt Dr S Ste A Fargo ND 58104-9140 Ph: (701) 566-5306 | Reviv PLLC 3029 Brandt Dr S Ste A Fargo ND 58104-9140 Ph: (701) 566-5306 |
| NPI Number | 1114595824 |
|---|---|
| Provider Enumeration Date | 06/17/2021 |
| Last Update Date | 02/04/2025 |
| Certification Date | 02/04/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114595824 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | () | Primary |
| 261QH0100X | Clinic/center - Health Service | () | Secondary |
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