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General NPI Number Information
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NPI Number | 1710797287
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Entity Type | Organization
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Legal Business Name | REVIVE DRIP
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Dates
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Enumeration Date | 01/08/2025
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 5800 SOUNDVIEW DR STE B201
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City | GIG HARBOR
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State | WA
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Zip | 98335-2064
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Country | US
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Telephone | 253-858-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 5800 SOUNDVIEW DR STE B201
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City | GIG HARBOR
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State | WA
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Zip | 98335-2064
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Country | US
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Telephone | 253-858-3800
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | HEATHER POUNDS
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Credential | ARNP
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Telephone | 253-222-4939
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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 |
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