Healthcare Provider Details

I. General information

NPI: 1164017752
Provider Name (Legal Business Name): HAMPTON ROADS WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 EXECUTIVE DR STE B
HAMPTON VA
23666-2402
US

IV. Provider business mailing address

2100 EXECUTIVE DR STE B
HAMPTON VA
23666-2402
US

V. Phone/Fax

Practice location:
  • Phone: 757-904-3319
  • Fax: 833-301-0790
Mailing address:
  • Phone: 757-904-3319
  • Fax: 833-301-0790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: WINTER LAUREN SEWARD-DIXON
Title or Position: NURSE PRACTITIONER
Credential: FNP-C
Phone: 757-904-3319