REVIVE CENTER FOR HEALTH & WELLNESS PLLC NPI 1548917594

NPI Information

REVIVE CENTER FOR HEALTH & WELLNESS, PLLC is a family nurse practitioner in Vernon, CT. REVIVE CENTER FOR HEALTH & WELLNESS, PLLC NPI is 1548917594. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

281 HARTFORD TPKE STE 106
VERNON, CT
ZIP 06066-760
Phone: (860) 375-2227
Fax: (860) 603-5080

The provider's authorized official is Jennifer Maria Sousa Jerome .
The authorized official title is Nurse Practitioner and has the following contact phone number (860) 375-2227.

The CLIA number assigned to this NPI record is 07D2263811 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/9/2022 and was last updated on 4/28/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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