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General NPI Number Information
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NPI Number | 1679062483
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Entity Type | Organization
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Legal Business Name | REVITALIZED HEALTH, LLC.
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Dates
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Enumeration Date | 05/07/2018
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Last Update Date | 05/07/2018
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Provider Practice Location Address
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Address Line | 7761 SHAFFER PKWY STE 120
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City | LITTLETON
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State | CO
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Zip | 80127-3729
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Country | US
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Telephone | 720-361-2302
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Fax | 720-728-8617
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Provider Business Mailing Address
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Address Line | 7761 SHAFFER PKWY STE 120
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City | LITTLETON
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State | CO
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Zip | 80127-3729
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Country | US
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Telephone | 720-361-2302
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Fax | 720-728-8617
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Authorized Official
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Title or Position | OWNER/NURSE PRACTITIONER
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Name | MR. JOHN RICHARD FLAUDING
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Credential | NP-C
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Telephone | 720-361-2302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | CO
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