Organization
REVIVAL WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHAN BRYANT MALEK CNP (CEO)
(320) 491-0594
Entity
Organization
Contact information
Practice address
511 OREGON AVE PDT SUITE B3, MORRIS, MN 56267
(320) 491-0594
(320) 491-0594
Mailing address
511 OREGON AVE, MORRIS, MN 56267-3712
(320) 491-0594
(320) 491-0594
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
—
—
Other
Enumeration date
10/24/2025
Last updated
10/24/2025
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