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General NPI Number Information
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NPI Number | 1063072551
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Entity Type | Organization
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Legal Business Name | REVELATION HEALTH & WELLNESS LLC
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Dates
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Enumeration Date | 06/17/2019
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Last Update Date | 10/22/2019
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Provider Practice Location Address
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Address Line | 249 OLSON DR STE 103
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City | PAPILLION
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State | NE
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Zip | 68046-2974
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Country | US
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Telephone | 712-269-8177
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Fax |
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Provider Business Mailing Address
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Address Line | 249 OLSON DR STE 103
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City | PAPILLION
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State | NE
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Zip | 68046-2974
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Country | US
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Telephone | 402-715-4855
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Fax | 402-916-4169
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. BROOK LAPKE
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Credential |
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Telephone | 402-715-4855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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