Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Revitalize Your Wellness

Organization Family Medicine Physician · NPI 1194647172

Revitalize Your Wellness is a Family Medicine Physician in Zimmerman, Minnesota. Registered with an NPI since 2026.

In the registry since
2026

Practice location Address checks out

12025 276th Ave NW
Zimmerman, MN 55398-8923
Phone: (651) 416-1301
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X

Record details

NPI number1194647172
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Mikayla Siemsen — Family Nurse Practitioner · (651) 416-1301
NPI enumeratedJuly 29, 2026
Last updated in NPPESJuly 29, 2026
Certification dateJuly 29, 2026
Mailing address12025 276th Ave Nw, Zimmerman, MN 55398-8923

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