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Organization
REVIVE WELLNESS L.L.C.
Active
Organization
REVIVE WELLNESS L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE CHAMBERS NP (NURSE PRACTITIONER)
(941) 626-1031
Entity
Organization
Contact information
Practice address
8302 NOTTINGHAM PKWY, LOUISVILLE, KY 40222-5540
(502) 468-5003
Mailing address
8302 NOTTINGHAM PKWY, LOUISVILLE, KY 40222-5540
(502) 468-5003
Taxonomy
Speciality
Code
Description
License number
State
2083B0002X
Obesity Medicine (Preventive Medicine) Physician
—
NULL
2083B0002X
Obesity Medicine (Preventive Medicine) Physician
—
—
363LA2200X
Adult Health Nurse Practitioner
Primary
—
NULL
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
12/07/2023
Last updated
12/07/2023
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