Revitaderm Pllc
NPI #1518770494 in Newark, Texas
Provider Information
- NPI Number
- 1518770494
- Entity Type
- Organization
- Organization Name
- Revitaderm Pllc
- Primary Specialty
- Registered Nurse
- Enumeration Date
- Jan 27, 2025
- Last Updated
- Jan 27, 2025
Practice Location
Authorized Official
- Name
- BROOKE ASHLEY MACKIE, PART OWNER
- Title
- RN
- Phone
- (817) 992-5066
Specialties & Taxonomy Codes
| Specialty |
|---|
| Registered Nurse |
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