| Organization Name: | RENOVATION HEALTH AND WELLNESS |
| NPI Number: | 1336561943 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PATRICIA EBERHARTER (CHIEF OFFICER/OWNER) |
| Mailing Address: | 2707 Jacksboro Pike Suite 1a Jacksboro |
| State: | TN US |
| Postal Code: | 377572752 |
| Phone Number: | 4239078186 |
| Fax Number: | 4239078187 |
| NPI Enumeration Date: | 01/16/2014 |
| NPI Last Update Date: | 01/16/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364SF0001X |
| License Number: | 14789 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | Family Health |
| Taxonomy Definition: | |