Reviv PLLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

REVIV PLLC

Practice address

3029 Brandt Dr S Ste a
Fargo, ND 58104-9140

Phone

(701) 566-5306

NPI assigned

Jun 17, 2021

Last updated

Feb 4, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Laura Lisa Job

Title

Operations Manager

Phone

(701) 526-6530

Specialties & licenses 2

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Erin Eliza Lubitz, BS, RN, DNP-C

  • Primary Care Nurse Practitioner
  • Fargo, ND
  • NPI 1043822455
  NPD
• Kyra Diede, AGNP-C

  • Adult Health Nurse Practitioner
  • Jamestown, ND
  • NPI 1366217978
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738627200000",
    "number": "1114595824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3029 BRANDT DR S STE A",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581049140",
            "telephone_number": "701-566-5306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3029 BRANDT DR S STE A",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581049140",
            "telephone_number": "701-566-5306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIV PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-17",
        "last_updated": "2025-02-04",
        "certification_date": "2025-02-04",
        "status": "A",
        "authorized_official_last_name": "JOB",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "LISA",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "701-526-6530",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandra W Retzlaff, LRD
• Angela Reule, RD
• Patric A Reuter, CRNA
• Olivia Revels-Strother
• Revitalize Chiropractic, LLC
• Paul B Revland, PHD
• Joey Lee Rexine, MD
• Michelle Jill Rexine
• Norberto Reyes Olsson, LCSW
• Vanessa K Reyes

• General Practice Physician in Fargo, ND
• Providers in Fargo, ND by specialty
• General Practice Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.