Revive of Colorado, PLLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

AG09170063 Issued in CO

Legal business name

REVIVE OF COLORADO, PLLC

Practice address

218 E Cheyenne Mountain Blvd
Colorado Springs, CO 80906-3720

Phone

(719) 396-3003

Fax

(719) 396-3003

NPI assigned

Apr 5, 2018

Organization subpart

No

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

Authorized official

Name

Deirdre Raquel Wolf, AGNP-C

Title

Ceo

Phone

(719) 396-3003

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1522886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522886400000",
    "number": "1609372838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "218 E CHEYENNE MOUNTAIN BLVD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809063720",
            "telephone_number": "719-396-3003",
            "fax_number": "719-396-3003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218 E CHEYENNE MOUNTAIN BLVD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809063720",
            "telephone_number": "719-396-3003",
            "fax_number": "719-396-3003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE OF COLORADO, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-05",
        "last_updated": "2018-04-05",
        "status": "A",
        "authorized_official_last_name": "WOLF",
        "authorized_official_first_name": "DEIRDRE",
        "authorized_official_middle_name": "RAQUEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "719-396-3003",
        "authorized_official_credential": "AGNP-C"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": "CO",
            "license": "AG09170063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Reveille Recovery, LLC
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• Revival Therapy Services LLC
• Revolution Rehabilitation P. C. (Revolution Rehabilitation Inc)
• Tina M Reyero, LPC
• Jamie Reyes-Morales, RBT
• Abigail Reyes
• Alexa Reyes

• Nurse Practitioner in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Nurse Practitioner in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2018; 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.