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Organization

REVIVAL LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
STEPHANIE RIEHL CNP (OWNER/CNP)
(207) 843-9591
Entity
Organization

Contact information

Practice address
139 STATE ST STE 2, BANGOR, ME 04401-5317
(207) 843-9591
Mailing address
51 FLETCHER RD, DOVER FOXCROFT, ME 04426-3715

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary

Other

Enumeration date
01/08/2024
Last updated
01/08/2024
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