Organization Active NPI

Revolution Longevity and Wellness LLC

  • Nurse Practitioner
  • Stratham, NH
National Provider Identifier
1932096674
Registry record updated Jun 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
REVOLUTION LONGEVITY AND WELLNESS LLC
Practice address
91 Portsmouth Ave
Stratham, NH 03885-2468
Phone
(603) 793-5969
NPI assigned
Jun 23, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2025

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

Authorized official

Name
Ann Fisher, NPNPI 1528446085
Title
Owner/NP
Phone
(603) 793-5969

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

91 Portsmouth Ave
Stratham, NH 03885-2468

Mailing address

91 Portsmouth Ave
Stratham, NH 03885-2468
Phone (603) 793-5969

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
30D2321644Revolution Longevity and Wellness LLC91 Portsmouth Ave, Ste E, Stratham, NH 03885Certificate of waiverApr 7, 2027

National Provider Directory

National Provider Directory

Locations

91 Portsmouth Ave
Stratham, NH 03885
Phone (603) 793-5969

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1750636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750636800000",
    "number": "1932096674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "91 PORTSMOUTH AVE",
            "city": "STRATHAM",
            "state": "NH",
            "postal_code": "038852468",
            "telephone_number": "603-793-5969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "91 PORTSMOUTH AVE",
            "city": "STRATHAM",
            "state": "NH",
            "postal_code": "038852468",
            "telephone_number": "603-793-5969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVOLUTION LONGEVITY AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-23",
        "last_updated": "2025-06-23",
        "certification_date": "2025-06-23",
        "status": "A",
        "authorized_official_last_name": "FISHER",
        "authorized_official_first_name": "ANN",
        "authorized_official_title_or_position": "OWNER/NP",
        "authorized_official_telephone_number": "603-793-5969",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stratham, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.