Organization
REVIVE MEDICAL & AESTHETIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FLORENCE UKENYE FNP (CLINICAL DIRECTOR)
(301) 412-5522
Entity
Organization
Contact information
Practice address
7313 HANOVER PKWY STE A, GREENBELT, MD 20770-3667
(301) 412-5522
(301) 498-7436
Mailing address
7313 HANOVER PKWY STE A, GREENBELT, MD 20770-3667
(301) 412-5522
(301) 498-7436
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
—
Enumeration date
11/29/2022
Last updated
11/29/2022
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