Organization
REVIVIFY BIOLOGICS
Active
Other names
Revivify Biologics
Organization subpart
No
Provider details
NPI number
Authorized official
ELLEN ROSE BECKER AGNP (NURSE PRACTIONER)
(817) 886-4319
Entity
Organization
Contact information
Practice address
4100 HERITAGE AVE, GRAPEVINE, TX 76051-5714
(817) 886-4319
Mailing address
62 MAIN ST STE 110, COLLEYVILLE, TX 76034-2931
(817) 886-4319
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
11/20/2017
Last updated
11/20/2017
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