Dr. Revivajennz Med Spa, PLLC
Clinic/Center in Ann Arbor, MI. Organization (NPI-2).
NPI number1083310312
StatusActive
Last updated in NPPESFeb 7, 2023
Details
- NPI
- 1083310312
- Entity type
- Organization (NPI-2)
- Legal business name
- Dr. Revivajennz Med Spa, PLLC
- Organization subpart
- No
- Enumeration date
- Feb 7, 2023
- Certification date
- Feb 7, 2023
- Last updated
- Feb 7, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261Q00000X | Clinic/Center | – | – | Yes |
Practice location
418 S Wagner RdAnn Arbor, MI 48103-1944
Phone 734-355-3566
Mailing address
4870 Birkdale DrAnn Arbor, MI 48103-9743
Phone 734-355-3566
Authorized official
Jennifer Thomas-Goering
Medical Director
7343553566
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