| Revive Health And Wellness Llc | |
|
1550 E Florence Blvd Ste 104 Casa Grande AZ 85122-4788 | |
| (520) 483-6386 | |
| Not Available |
| Full Name | Revive Health And Wellness Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1550 E Florence Blvd Ste 104, Casa Grande, Arizona |
| Authorized Official Name and Position | Diane Herrera (PRACTICE MANAGER) |
| Authorized Official Contact | 5204831698 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Health And Wellness Llc 1550 E Florence Blvd Ste 104 Casa Grande AZ 85122-4788 Ph: (520) 635-5318 | Revive Health And Wellness Llc 1550 E Florence Blvd Ste 104 Casa Grande AZ 85122-4788 Ph: (520) 483-6386 |
| NPI Number | 1528742814 |
|---|---|
| Provider Enumeration Date | 06/15/2023 |
| Last Update Date | 12/18/2023 |
| Medicare PECOS PAC ID | 5092179424 |
|---|---|
| Medicare Enrollment ID | O20230918002893 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528742814 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Jami Mary Elizabeth Jacobsen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609344464 PECOS PAC ID: 4284960741 Enrollment ID: I20190723000596 |
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