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General NPI Number Information
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NPI Number | 1598595894
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Entity Type | Organization
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Legal Business Name | IV REVIVAL SERVICES PLLC
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Dates
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Enumeration Date | 08/02/2024
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 7373 N SCOTTSDALE RD STE D235
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City | SCOTTSDALE
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State | AZ
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Zip | 85253-5515
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Country | US
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Telephone | 607-329-5414
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Fax |
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Provider Business Mailing Address
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Address Line | 2781 E SAN TAN ST
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City | CHANDLER
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State | AZ
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Zip | 85225-4069
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Country | US
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Telephone | 607-329-5414
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER EASTMAN
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Credential | MSN, RN
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Telephone | 607-329-5414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State |
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