Organization · Type 2 NPI
Core Revive / Soul Revive LLC
Nutrition Support Registered Nurse · Petaluma, CA
NPI number
1154826980
Active
Practice location
16 Queens Ln
Petaluma, CA 94952-1047
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Diabetes Educator Registered Nurse | 163WD0400X | 846331 (CA) |
| Nutrition Support Registered Nurse Primary | 163WN1003X | 846331 (CA) |
Nutrition Support Registered Nurse: Definition to come...
About NPI 1154826980
Core Revive / Soul Revive LLC's National Provider Identifier is 1154826980, issued on Mar 26, 2018. The primary taxonomy on file is Nutrition Support Registered Nurse (163WN1003X), and the practice location is in Petaluma, CA. The record was last updated on Jun 11, 2019.