Organization
DIVERSE HEALTHCARE INC
Active
Other names
Meraki Health and Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
MS. STEPHANIE GAYLES LANE (PRESIDENT/CEO)
(757) 320-8619
Entity
Organization
Contact information
Practice address
509 WINE ST, HAMPTON, VA 23669-3162
(757) 320-8619
Mailing address
509 WINE ST, HAMPTON, VA 23669-3162
(757) 320-8619
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
128145
VA
Other
Enumeration date
02/21/2017
Last updated
02/21/2017
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