Organization
REVIVE-
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LAFREDDRIA A HANNIBLE (DIRECTOR)
(262) 510-3784
Entity
Organization
Contact information
Practice address
9450 PINECROFT DR, THE WOODLANDS, TX 77380-3220
(262) 510-3784
Mailing address
4029 N 72ND ST, MILWAUKEE, WI 53216-1033
(262) 510-3784
Taxonomy
Speciality
Code
Description
License number
State
343800000X
Secured Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
07/18/2024
Last updated
07/18/2024
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