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General NPI Number Information
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NPI Number | 1679252084
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Entity Type | Organization
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Legal Business Name | BEWELL- LIFESTYLE & FUNCTIONAL HEALTH
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Dates
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Enumeration Date | 07/13/2023
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 337 MAIN ST
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City | SMITHFIELD
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State | VA
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Zip | 23430-1346
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Country | US
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Telephone | 434-294-2416
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Fax |
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Provider Business Mailing Address
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Address Line | 10438 OAK SPRING RD
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City | CARROLLTON
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State | VA
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Zip | 23314-4130
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Country | US
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Telephone | 434-294-2416
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | COLLEEN MEISER
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Credential | RN, MSN, FNP-C
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Telephone | 434-294-2416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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