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General NPI Number Information
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NPI Number | 1437869690
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Entity Type | Organization
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Legal Business Name | REVIA HEALTH AND WELLNESS, LLC
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Dates
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Enumeration Date | 11/29/2022
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 7641 N UNION BLVD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-3863
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Country | US
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Telephone | 719-582-5500
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Fax |
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Provider Business Mailing Address
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Address Line | 7641 N UNION BLVD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-3863
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Country | US
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Telephone | 719-494-3948
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Fax | 949-695-4411
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Authorized Official
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Title or Position | OWNER, NURSE PRACTITIONER
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Name | JUSTINE SHERMAN
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Credential | NP
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Telephone | 719-494-3948
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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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