Organization
REVIVE & RENEW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE WASCHER APN (ADVANCED PRACTICE NURSE)
(815) 573-8464
Entity
Organization
Contact information
Practice address
716 S MAIN ST, LOMBARD, IL 60148-3344
(815) 573-8464
Mailing address
1S122 ELIOT LN, VILLA PARK, IL 60181-3710
(815) 573-8464
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
08/04/2025
Last updated
08/04/2025
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