Revive Wellness and Rejuvenation LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

REVIVE WELLNESS AND REJUVENATION LLC

Practice address

20229 N 67TH Ave Ste C-a
Glendale, AZ 85308-6664

Phone

(602) 595-7836

NPI assigned

Mar 30, 2020

Last updated

May 1, 2020By 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

Robert Graham, DCNPI 1639299183

Title

President

Phone

(602) 595-7836

Specialties & licenses 1

Addresses

Locations

Practitioners 3

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.

• Robert W Graham, D.C.

  • Chiropractor
  • Glendale, AZ
  • NPI 1639299183
  NPD Authorized official
• Alexandra Birkett, PA-C

  • Medical Physician Assistant
  • Peoria, AZ
  • NPI 1053742197
  NPD
• Sabrina Michelle Solt, N.M.D.

  • Naturopath
  • Scottsdale, AZ
  • NPI 1336501535
  NPD (past)

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

{
    "created_epoch": "1585526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588291200000",
    "number": "1184252678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20229 N 67TH AVE STE C-A",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853086664",
            "telephone_number": "602-595-7836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20229 N 67TH AVE STE C-A",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853086664",
            "telephone_number": "602-595-7836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE WELLNESS AND REJUVENATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-30",
        "last_updated": "2020-05-01",
        "certification_date": "2020-05-01",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "602-595-7836",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Resurreccion
• Jeannie M Retamal
• Elizabeth Rettig, AUD
• Revival Home Care
• Revive Wellness & Rejuvenation
• Jacob Reyes
• Lisa T. Reyes, O.D.
• Virginia Rivas Reyes
• Elizabeth Michele Reyna
• Bassem Rezk

• Family Nurse Practitioner in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2020; 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.