Revival Wellness LLC

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

Legal business name

REVIVAL WELLNESS LLC

Practice address

511 Oregon Ave PDT Suite B3
Morris, MN 56267

Phone

(320) 491-0594

Fax

(320) 491-0594

NPI assigned

Oct 24, 2025

Last updated

Oct 24, 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

Nathan Bryant Malek, CNPNPI 1518735067

Title

Ceo

Phone

(320) 491-0594

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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.

• Nathan Bryant Malek, CNP

  • Family Nurse Practitioner
  • Morris, MN
  • NPI 1518735067
  NPD Authorized official

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

{
    "created_epoch": "1761264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761264000000",
    "number": "1790653533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 OREGON AVE",
            "city": "MORRIS",
            "state": "MN",
            "postal_code": "562673712",
            "telephone_number": "320-491-0594",
            "fax_number": "320-491-0594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 OREGON AVE PDT SUITE B3",
            "city": "MORRIS",
            "state": "MN",
            "postal_code": "56267",
            "telephone_number": "320-491-0594",
            "fax_number": "320-491-0594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVAL WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-24",
        "last_updated": "2025-10-24",
        "certification_date": "2025-10-07",
        "status": "A",
        "authorized_official_last_name": "MALEK",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_middle_name": "BRYANT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "320-491-0594",
        "authorized_official_credential": "CNP"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Renee Raths, FNP
• Julain Rayman, LMFT
• Lori J Reimers, P.T.
• Morgan Reimers
• Tyler Reimers
• Evy Rodne-Cole, L.P.
• RWF Enterprises Inc (Stevens County Ambulance Service)
• Sanford Medical Center Fargo (Sanford Dialysis Morris)
• Francine Schapiro
• John Henry Schmidgall

• Adult Medicine Physician in Morris, MN
• Providers in Morris, MN by specialty
• Adult Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 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.