Organization
REVIVE WELLNESS AND AESTHETICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELSEY MARTIN DNP, FNP-C (OWNER/NURSE PRACTITIONER)
(217) 617-2575
Entity
Organization
Contact information
Practice address
445 S FITNESS PL # 130, EAGLE, ID 83616-6828
(208) 939-2332
Mailing address
4253 N SORREL PL, BOISE, ID 83703-3487
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
07/21/2023
Last updated
07/21/2023
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