| Revive Medical Spa Llc | |
|
1905 Cowles St Ste B Fairbanks AK 99701-5914 | |
| (907) 371-1766 | |
| (907) 531-7365 |
| Full Name | Revive Medical Spa Llc |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 1905 Cowles St Ste B, Fairbanks, Alaska |
| Authorized Official Name and Position | Karolina Priebe (OWNER/PARTNER/NURSE PRACTITIONER) |
| Authorized Official Contact | 9073711766 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Medical Spa Llc 1905 Cowles St Ste B Fairbanks AK 99701-5914 Ph: (907) 371-1766 | Revive Medical Spa Llc 1905 Cowles St Ste B Fairbanks AK 99701-5914 Ph: (907) 371-1766 |
| NPI Number | 1467175943 |
|---|---|
| Provider Enumeration Date | 09/21/2022 |
| Last Update Date | 09/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467175943 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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