Organization
REVITALIZE HYDRATION THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNYE MARDIS RN (STAFF)
(601) 213-0069
Entity
Organization
Contact information
Practice address
885 LIBERTY RD STE 300, FLOWOOD, MS 39232-9006
(601) 213-0069
Mailing address
885 LIBERTY RD STE 300, FLOWOOD, MS 39232-9006
(601) 213-0069
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
—
—
Other
Enumeration date
03/23/2020
Last updated
11/10/2020
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