REVIVE CLINIC AND SPA (NPI# 1205479888) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205479888 |
| Entity Type | Organization |
| Organization Name | REVIVE CLINIC AND SPA |
| Practice Address |
1850 Sw Plaza Shops Ln Ste A Ankeny IA 50023-7168 |
| Practice Telephone | 5159655677 |
| Mailing Telephone | 5159655677 |
| Enumeration Date | 2019-10-25 |
| Last Update Date | 2019-11-21 |
| Authorized Official Name | STEFANIE GATICA (OWNER) |
| Authorized Official Telephone | 5159655677 |
| Authorized Official Credential | ARNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Iowa Business Entities | REVIVE CLINIC AND SPA, PLLC | 1850 Sw Plaza Shop Lane, Suite A, Ankeny, IA 50023 |
| Street Address |
1850 SW PLAZA SHOPS LN STE A |
| City | ANKENY |
| State | IA |
| Zip Code | 50023-7168 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356956916 | Jennifer Cherop Cheruiyot | Nurse Practitioner | 215 Nw 18th St, Ankeny Ia 50023, Ankeny, IA 50023 | 2020-09-10 |
| 1659904803 | Ikc, LLC | Clinic/Center | 8736 Nw 27th Court, Ankeny, IA 50023 | 2020-02-17 |
| 1104457126 | Achieve Tms Centers Central PC | Psychiatry & Neurology | 1517 N. Ankeny Blvd., Suite E, Ankeny, IA 50023 | 2020-01-29 |
| 1023663994 | Janet Lynn Rieckhoff | Counselor | 1517 N. Ankeny Blvd, Suite D, Ankeny, IA 50023 | 2019-08-07 |
| 1790344158 | Jacquelyn Olson Leech | Counselor | 2301 W. 1st Street, Ste 4, Ankeny, IA 50023 | 2019-06-10 |
| 1063077717 | Benjamin Kohler | Chiropractor | 1201 Sw State St, Suite 101, Ankeny, IA 50023 | 2019-05-08 |
| 1831657857 | Michael E Mcinroy | Counselor | 1609 N. Ankeny Blvd., Suite 210, Ankeny, IA 50023 | 2019-03-08 |
| 1396231825 | Catherine Walters | Counselor | 1609 N. Ankeny Blvd, Suite 210, Ankeny, IA 50023 | 2018-07-09 |
| 1053804617 | Ankeny Family Counseling | Counselor | 2301 W. 1st St. #4, Ankeny, IA 50023 | 2018-06-08 |
| 1952831521 | Michael Weston Sinklier | Family Medicine | 1360 Nw 18th Street, Ste 102, Ankeny, IA 50023 | 2017-06-15 |
| Find all providers in zip 50023 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225655590 | Maria Elizabeth Decker | Nurse Practitioner | 3941 Sw 5th Ct, Ankeny, IA 50023-9258 | 2020-07-02 |
| 1649897190 | Rebecca Ann Mischel | Nurse Practitioner | 600 Nw Linden St, Ankeny, IA 50023-1441 | 2020-07-01 |
| 1255953733 | Julianne Marie Patterson | Nurse Practitioner | 406 Ne 17th St, Ankeny, IA 50021-4145 | 2020-05-07 |
| 1902439409 | Jessica Rae Maifield | Nurse Practitioner | 619 Nw Reinhart Dr, Ankeny, IA 50023-7934 | 2020-02-13 |
| 1720618788 | Shana Lynn Martinez | Nurse Practitioner | 1012 Nw 32nd St, Ankeny, IA 50023-7834 | 2020-01-18 |
| 1881160794 | Caylen Cable | Nurse Practitioner | 2408 Nw Ashton Ln Unit 6, Ankeny, IA 50023-7816 | 2018-10-18 |
| 1821285396 | Mikal Tess Rasmussen | Nurse Practitioner | 1609 N. Ankeny Blvd Suite #200, Acute Care, Inc, Ankeny, IA 50023 | 2007-09-28 |
| 1396254793 | Teresa Ward | Nurse Practitioner | 800 E 1st St Ste 1700, Ankeny, IA 50021-2100 | 2017-09-28 |
| 1962958710 | Kera Casber | Nurse Practitioner | 800 E. First Street, Suite 1700, Ankeny, IA 50021-2100 | 2016-08-31 |
| 1780041178 | Abby Bennett | Nurse Practitioner | 1410 Sw Tradition Dr Ste 110, Ankeny, IA 50023-9188 | 2016-01-15 |
| Find all providers in ANKENY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.