Organization
REVERE WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB HARRISON FNP (OWNER)
(865) 455-4817
Entity
Organization
Contact information
Practice address
1333 MEADOWBROOK DR, PULASKI, TN 38478-5002
(865) 455-4817
Mailing address
1333 MEADOWBROOK DR, PULASKI, TN 38478-5002
(865) 455-4817
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
07/08/2020
Last updated
07/08/2020
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