| Diverse Wellness Solutions Inc | |
|
7155 Sunset Lake Rd Fuquay Varina NC 27526-8638 | |
| (919) 838-0804 | |
| (919) 838-1219 |
| Full Name | Diverse Wellness Solutions Inc |
|---|---|
| Speciality | Clinical Nurse Specialist |
| Location | 7155 Sunset Lake Rd, Fuquay Varina, North Carolina |
| Authorized Official Name and Position | Kimball Jane-marie Sargent (OWNER/PRESIDENT) |
| Authorized Official Contact | 9198380804 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Diverse Wellness Solutions Inc 7155 Sunset Lake Rd Fuquay Varina NC 27526-8638 Ph: (919) 838-0804 | Diverse Wellness Solutions Inc 7155 Sunset Lake Rd Fuquay Varina NC 27526-8638 Ph: (919) 838-0804 |
| NPI Number | 1912299173 |
|---|---|
| Provider Enumeration Date | 05/06/2011 |
| Last Update Date | 01/06/2016 |
| Medicare PECOS PAC ID | 9739359811 |
|---|---|
| Medicare Enrollment ID | O20110829000020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912299173 | NPI | - | NPPES |
| NCMC030788 | Medicaid | NC | |
| 6004025 | Medicaid | NC | |
| 527619 | Other | NC | VALUE OPTIONS |
| NC1277A203 | Other | NC | MEDICARE PTAN |
| 10079 | Other | NC | BCBS |
| Provider Name | Kimball J Sargent |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1174570808 PECOS PAC ID: 4284804360 Enrollment ID: I20110829000034 |
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