Provider Demographics
NPI:1063072551
Name:REVELATION HEALTH & WELLNESS LLC
Entity type:Organization
Organization Name:REVELATION HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BROOK
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-715-4855
Mailing Address - Street 1:249 OLSON DR STE 103
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-2974
Mailing Address - Country:US
Mailing Address - Phone:402-715-4855
Mailing Address - Fax:402-916-4169
Practice Address - Street 1:249 OLSON DR STE 103
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-2974
Practice Address - Country:US
Practice Address - Phone:712-269-8177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-17
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care