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General NPI Number Information
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NPI Number | 1033850516
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Entity Type | Organization
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Legal Business Name | REVIVED HEALTH AND WELLNESS
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Dates
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Enumeration Date | 04/06/2022
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Last Update Date | 04/06/2022
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Provider Practice Location Address
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Address Line | 102 PLEASANT ST STE 2
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City | CONCORD
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State | NH
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Zip | 03301-3863
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Country | US
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Telephone | 603-573-1057
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Fax | 877-471-0534
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Provider Business Mailing Address
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Address Line | 102 PLEASANT ST STE 2
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City | CONCORD
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State | NH
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Zip | 03301-3863
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Country | US
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Telephone | 603-573-1057
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Fax | 877-471-0534
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Authorized Official
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Title or Position | OWNER
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Name | MCCALL ABBOTT
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Credential | APRN
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Telephone | 603-848-7875
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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