Provider Demographics
NPI:1679252084
Name:BEWELL- LIFESTYLE & FUNCTIONAL HEALTH
Entity Type:Organization
Organization Name:BEWELL- LIFESTYLE & FUNCTIONAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEISER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, FNP-C
Authorized Official - Phone:434-294-2416
Mailing Address - Street 1:10438 OAK SPRING RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:VA
Mailing Address - Zip Code:23314-4130
Mailing Address - Country:US
Mailing Address - Phone:434-294-2416
Mailing Address - Fax:
Practice Address - Street 1:337 MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-1346
Practice Address - Country:US
Practice Address - Phone:434-294-2416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty