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General NPI Number Information
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NPI Number | 1750019147
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Entity Type | Organization
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Legal Business Name | REVIVE HEALTH CONCIERGE
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Dates
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Enumeration Date | 08/12/2022
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Last Update Date | 07/26/2023
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Provider Practice Location Address
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Address Line | 2800 E MADISON ST STE 201
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City | SEATTLE
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State | WA
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Zip | 98112-4865
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Country | US
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Telephone | 206-717-5622
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Fax | 949-561-4815
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Provider Business Mailing Address
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Address Line | 2800 E MADISON ST STE 201
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City | SEATTLE
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State | WA
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Zip | 98112-4865
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Country | US
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Telephone | 206-717-5622
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Fax | 855-631-4133
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | LESLIE CASIAS
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Credential | ARNP
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Telephone | 206-717-5622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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