Organization
REVISION WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS ANGELA BORRELL CRNP (OWNER -CLINICAL PROVIDER)
(443) 513-0500
Entity
Organization
Contact information
Practice address
11312 MANKLIN CREEK RD UNIT 5, BERLIN, MD 21811-4009
(443) 513-5000
(888) 307-9020
Mailing address
11312 MANKLIN CREEK RD UNIT 5, BERLIN, MD 21811-4009
(443) 513-0500
(888) 307-9020
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
—
—
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
—
—
2083B0002X
Obesity Medicine (Preventive Medicine) Physician
—
—
2083P0901X
Public Health & General Preventive Medicine Physician
—
—
261Q00000X
Clinic/Center
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1457683740
INDIVIDUAL NPI ASSOCIATED WITH REVISION WELLNESS
MD
01
—
1497390702
GROUP NPI
MD
05
—
722026000
—
MD
Enumeration date
11/11/2019
Last updated
02/14/2026
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