Organization
MEDIZEN REVITALIZE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DELICIA BAWL (OWNER)
(316) 807-3069
Entity
Organization
Contact information
Practice address
11407 W SONDRA ST, MAIZE, KS 67101-9014
(316) 285-0505
(763) 314-4990
Mailing address
11407 W SONDRA ST, MAIZE, KS 67101-9014
(316) 285-0505
(763) 314-4990
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
03/13/2026
Last updated
03/13/2026
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