Provider Demographics
NPI:1710797287
Name:REVIVE DRIP
Entity type:Organization
Organization Name:REVIVE DRIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:POUNDS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:253-222-4939
Mailing Address - Street 1:5800 SOUNDVIEW DR STE B201
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-2064
Mailing Address - Country:US
Mailing Address - Phone:253-858-3800
Mailing Address - Fax:
Practice Address - Street 1:5800 SOUNDVIEW DR STE B201
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-2064
Practice Address - Country:US
Practice Address - Phone:253-858-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty