# REVIVIFY BIOLOGICS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Revivify Biologics
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952815466
- **Authorized official:** ELLEN ROSE BECKER AGNP (NURSE PRACTIONER)
- **Authorized official phone:** (817) 886-4319

## Contact information

- **Practice address:** 4100 HERITAGE AVE, GRAPEVINE, TX 76051-5714
- **Practice address phone:** (817) 886-4319
- **Mailing address:** 62 MAIN ST STE 110, COLLEYVILLE, TX 76034-2931
- **Mailing address phone:** (817) 886-4319

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 11/20/2017
- **Last updated:** 11/20/2017