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

Reviv PLLC

Organization General Practice Physician · NPI 1114595824

Reviv PLLC is a General Practice Physician in Fargo, North Dakota. Registered with an NPI since 2021.

In the registry since
2021
Specialties on file
2
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

3029 Brandt Dr S Ste A
Fargo, ND 58104-9140
Phone: (701) 566-5306
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Physician (primary) Taxonomy 208D00000X
Health Service Clinic/Center Taxonomy 261QH0100X

Record details

NPI number1114595824
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Laura Job — Operations Manager · (701) 526-6530
NPI enumeratedJune 17, 2021
Last updated in NPPESFebruary 4, 2025
Certification dateFebruary 4, 2025
Mailing address3029 Brandt Dr S Ste A, Fargo, ND 58104-9140

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