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NPI Profile for REVIVAL WELLNESS LLC in MORRIS, MN.
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Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Adult Medicine |
207QA0505X | 08 | Physician/Family Practice |
| NPI Number | 1790653533 |
|
| Status | Active | |
| Credentials | ||
| Entity | Individual | |
| Enumeration date | 10/24/2025 | |
| Last updated | 10/24/2025 - About 7 months ago | |
| Sole proprietor 1 | Not specified | |
| Identifiers | Not Available | |
| Hospital affiliation(s) | Not Available |
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REVIVAL WELLNESS LLC
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| GLACIAL RIDGE HOSPITAL DISTRICT 111 PLEASANT AVENUE BROOTEN, MN |
REVIVAL WELLNESS LLC