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General NPI Number Information
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NPI Number | 1942944822
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Entity Type | Organization
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Legal Business Name | DIVERGENT HEALTH WELLNESS-NURSE PRACTITIONER IN ADULT HEALTH
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Dates
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Enumeration Date | 04/26/2022
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Last Update Date | 04/26/2022
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Provider Practice Location Address
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Address Line | 50 FOUNTAIN PLZ
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City | BUFFALO
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State | NY
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Zip | 14202-2230
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Country | US
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Telephone | 716-333-8761
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Fax | 716-271-9177
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Provider Business Mailing Address
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Address Line | PO BOX 1448
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City | AMHERST
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State | NY
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Zip | 14226-7448
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Country | US
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Telephone | 716-333-8761
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Fax | 716-271-9177
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Authorized Official
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Title or Position | OWNER
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Name | DUMADI FERNANDEZ
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Credential | NP
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Telephone | 716-333-8761
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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