=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851214548
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REVITAL GLOW AESTHETICS & WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2026
-----------------------------------------------------
Last Update Date | 07/31/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6810 FIVE STAR BLVD STE 300
-----------------------------------------------------
City | ROCKLIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95677-2698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-584-6037
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6810 FIVE STAR BLVD STE 300
-----------------------------------------------------
City | ROCKLIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95677-2698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-584-6037
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER, OWNER
-----------------------------------------------------
Name | NAKISHA SATTELMAIER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 253-468-5704
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------