Healthcare Provider Details

I. General information

NPI: 1205609245
Provider Name (Legal Business Name): SLEEP REMEDIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 S REGENT ST STE 101-18
FLAGSTAFF AZ
86001-5960
US

IV. Provider business mailing address

2756 W HIGHLAND MEADOWS DR
WILLIAMS AZ
86046-9179
US

V. Phone/Fax

Practice location:
  • Phone: 928-275-1252
  • Fax:
Mailing address:
  • Phone: 920-918-0843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MALLORY J NYENHUIS
Title or Position: CEO
Credential: DDS
Phone: 920-918-0843