NPI 1114595824

Reviv PLLC

Organisation General Practice Physician Fargo, ND

Practice location

Address: 3029 Brandt Dr S STE a, Fargo, ND 58104-9140
Phone: (701) 566-5306

Authorised official

Name: Laura Lisa Job
Title: Operations Manager
Phone: (701) 526-6530

Registered specialties (2)

General Practice Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208D00000X

Other General Practice providers in North Dakota →

Health Service Clinic/Center

Ambulatory Health Care Facilities Taxonomy 261QH0100X

Other Clinic/Center providers in North Dakota →

Registry record

NPI: 1114595824
Entity type: Organization
NPI issued: 17 Jun 2021
Record last updated: 4 Feb 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.