Provider Demographics
NPI:1285391300
Name:RENEW AND REVIVE, PLLC
Entity type:Organization
Organization Name:RENEW AND REVIVE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:NETLLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CURETON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:479-363-3247
Mailing Address - Street 1:1111 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:AR
Mailing Address - Zip Code:72855-4123
Mailing Address - Country:US
Mailing Address - Phone:479-363-3247
Mailing Address - Fax:479-777-8581
Practice Address - Street 1:1111 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:AR
Practice Address - Zip Code:72855-4123
Practice Address - Country:US
Practice Address - Phone:479-363-3247
Practice Address - Fax:479-777-8581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty