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General NPI Number Information
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NPI Number | 1639690159
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Entity Type | Organization
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Legal Business Name | NIRVANA MENTAL HEALTHCARE SERVICES INC
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Dates
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Enumeration Date | 07/06/2017
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 120 WATERFRONT ST STE 420
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City | NATIONAL HARBOR
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State | MD
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Zip | 20745-1122
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Country | US
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Telephone | 240-647-8262
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Fax | 575-636-2591
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Provider Business Mailing Address
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Address Line | PO BOX 8244
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City | ROSWELL
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State | NM
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Zip | 88202-8244
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Country | US
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Telephone | 575-624-2095
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AYANNA WILLIAMS
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Credential | CNP
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Telephone | 844-779-2437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | CNP-03247
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License Number State | NM
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