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

Revive Wellness and Rejuvenation LLC

Organization Family Nurse Practitioner · NPI 1184252678

Revive Wellness and Rejuvenation LLC is a Family Nurse Practitioner in Glendale, Arizona. Registered with an NPI since 2020.

In the registry since
2020
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

20229 N 67th Ave Ste C-A
Glendale, AZ 85308-6664
Phone: (602) 595-7836
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X

Record details

NPI number1184252678
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Robert Graham — President · (602) 595-7836
NPI enumeratedMarch 30, 2020
Last updated in NPPESMay 1, 2020
Certification dateMay 1, 2020
Mailing address20229 N 67th Ave Ste C-A, Glendale, AZ 85308-6664

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