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Organization
REVIVE SALON AND SPA
Active
Organization
REVIVE SALON AND SPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY LYNN ELIZABETH EICHERT NP (NURSE PRACTITIONER)
(704) 516-6782
Entity
Organization
Contact information
Practice address
5965 VILLAGE WAY, E207, SAN DIEGO, CA 92130-2475
(619) 293-7233
Mailing address
4328 MOUNT HUKEE AVE, SAN DIEGO, CA 92117-4738
(704) 516-6782
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
95005931
CA
Other
Enumeration date
02/06/2017
Last updated
02/06/2017
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