Provider Demographics
NPI:1942934542
Name:DIVERSE HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:DIVERSE HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:602-327-3250
Mailing Address - Street 1:4061 E MILKY WAY
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-6102
Mailing Address - Country:US
Mailing Address - Phone:602-327-3250
Mailing Address - Fax:
Practice Address - Street 1:4061 E MILKY WAY
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-6102
Practice Address - Country:US
Practice Address - Phone:602-327-3250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty