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1295693588 NPI number — REVIVE 3.2 WELLNESS NURSING PC

NPI Number: 1295693588
Health Care Provider/Practitioner: REVIVE 3.2 WELLNESS NURSING PC

Information about “1295693588” NPI (REVIVE 3.2 WELLNESS NURSING PC) exists in 1295693588 in HTML format HTML  |  1295693588 in plain Text format TXT  |  1295693588 in PDF (Portable Document Format) PDF  |  1295693588 in an XML format XML  formats.

NPI Number : 1295693588 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1295693588",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "REVIVE 3.2 WELLNESS NURSING PC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "10328 RESEDA BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NORTHRIDGE",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91326-3433",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "818-634-0082",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "10328 RESEDA BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NORTHRIDGE",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "91326-3433",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "818-634-0082",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/14/2026",
    "LastUpdateDate": "01/14/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "PALASIO",
    "AuthorizedOfficialFirstName": "DIANNE",
    "AuthorizedOfficialMiddleName": "KRISTINE",
    "AuthorizedOfficialTitle": "NURSE PRACTITIONER/CEO",
    "AuthorizedOfficialNamePrefix": "MS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "NP",
    "AuthorizedOfficialTelephoneNumber": "818-634-0082",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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