Revival LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

REVIVAL LLC

Practice address

139 State St Ste 2
Bangor, ME 04401-5317

Phone

(207) 843-9591

NPI assigned

Jan 8, 2024

Organization subpart

No

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

Authorized official

Name

Stephanie Riehl, CNP

Title

Owner/CNP

Phone

(207) 843-9591

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1704672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704672000000",
    "number": "1689444960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 FLETCHER RD",
            "city": "DOVER FOXCROFT",
            "state": "ME",
            "postal_code": "044263715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 STATE ST STE 2",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044015317",
            "telephone_number": "207-843-9591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-08",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-07",
        "status": "A",
        "authorized_official_last_name": "RIEHL",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "OWNER/CNP",
        "authorized_official_telephone_number": "207-843-9591",
        "authorized_official_credential": "CNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Bangor, ME
• Providers in Bangor, ME by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2024; 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.