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General NPI Number Information
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NPI Number | 1285311456
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Entity Type | Organization
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Legal Business Name | REVAMP SERVICES INC
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Dates
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Enumeration Date | 06/29/2023
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 1702 S 72ND ST STE D
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City | TACOMA
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State | WA
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Zip | 98408-1238
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Country | US
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Telephone | 206-327-8403
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Fax |
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Provider Business Mailing Address
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Address Line | 7705 S JUNETT ST
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City | TACOMA
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State | WA
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Zip | 98409-9026
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Country | US
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Telephone | 206-327-8403
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Fax | 206-299-3342
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Authorized Official
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Title or Position | CEO
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Name | DR. GRACE MWANGI
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Credential | DNP-FNP-C
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Telephone | 206-327-8403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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