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General NPI Number Information
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NPI Number | 1982556502
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Entity Type | Organization
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Legal Business Name | REVIVE AND THRIVE INTEGRATIVE MEDICINE LLC
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Dates
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Enumeration Date | 02/14/2026
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Last Update Date | 02/14/2026
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Provider Practice Location Address
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Address Line | 14074 PASCO MONTRA RD
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City | ANNA
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State | OH
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Zip | 45302-9708
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Country | US
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Telephone | 937-646-5026
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Fax | 888-222-6607
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Provider Business Mailing Address
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Address Line | 14074 PASCO MONTRA RD
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City | ANNA
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State | OH
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Zip | 45302-9708
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Country | US
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Telephone | 937-646-5026
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Fax | 888-222-6607
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CINDY FLEMING
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Credential | CNP
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Telephone | 937-646-5026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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