Provider Demographics
NPI:1942944822
Name:DIVERGENT HEALTH WELLNESS-NURSE PRACTITIONER IN ADULT HEALTH
Entity Type:Organization
Organization Name:DIVERGENT HEALTH WELLNESS-NURSE PRACTITIONER IN ADULT HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DUMADI
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:716-333-8761
Mailing Address - Street 1:PO BOX 1448
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-7448
Mailing Address - Country:US
Mailing Address - Phone:716-333-8761
Mailing Address - Fax:716-271-9177
Practice Address - Street 1:50 FOUNTAIN PLZ
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-2230
Practice Address - Country:US
Practice Address - Phone:716-333-8761
Practice Address - Fax:716-271-9177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health