Organization
REVIVE WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RACHEL TAYLOR (OWNER/MANAGER)
(985) 351-1673
Entity
Organization
Contact information
Practice address
704 POINCIANA AVE, MAMOU, LA 70554-2224
(337) 468-4038
Mailing address
PO BOX 821, CARENCRO, LA 70520-0821
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
03/05/2022
Last updated
03/05/2022
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