Provider Demographics
NPI:1033850516
Name:REVIVED HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:REVIVED HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MCCALL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:603-848-7875
Mailing Address - Street 1:102 PLEASANT ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3863
Mailing Address - Country:US
Mailing Address - Phone:603-573-1057
Mailing Address - Fax:877-471-0534
Practice Address - Street 1:102 PLEASANT ST STE 2
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3863
Practice Address - Country:US
Practice Address - Phone:603-573-1057
Practice Address - Fax:877-471-0534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty