| Revitalized Wellness Pllc | |
|
326 E 8th St Apt 206 Sioux Falls SD 57103-7038 | |
| (605) 423-7557 | |
| (605) 305-1175 |
| Full Name | Revitalized Wellness Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 326 E 8th St Apt 206, Sioux Falls, South Dakota |
| Authorized Official Name and Position | Kristi Lynn Ross (OWNER) |
| Authorized Official Contact | 2519799825 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revitalized Wellness Pllc 401 E 8th St Ste 214-7054 Sioux Falls SD 57103-7011 Ph: (605) 423-7557 | Revitalized Wellness Pllc 326 E 8th St Apt 206 Sioux Falls SD 57103-7038 Ph: (605) 423-7557 |
| NPI Number | 1760093025 |
|---|---|
| Provider Enumeration Date | 08/11/2020 |
| Last Update Date | 03/07/2024 |
| Certification Date | 03/07/2024 |
| Medicare PECOS PAC ID | 3173939758 |
|---|---|
| Medicare Enrollment ID | O20210305000252 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760093025 | NPI | - | NPPES |
| Provider Name | Kristi Ross |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982008827 PECOS PAC ID: 7517280332 Enrollment ID: I20210305000282 |
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