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General NPI Number Information
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NPI Number | 1669194064
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Entity Type | Organization
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Legal Business Name | NIRVANA HAIR VA LLC
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Dates
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Enumeration Date | 09/13/2022
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 10019 JEFFERSON AVE
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City | NEWPORT NEWS
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State | VA
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Zip | 23605-1044
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Country | US
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Telephone | 757-254-7197
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Fax |
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Provider Business Mailing Address
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Address Line | 10019 JEFFERSON AVE
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City | NEWPORT NEWS
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State | VA
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Zip | 23605-1044
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Country | US
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Telephone | 757-254-7197
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAREE NEWBY-SANDERS
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Credential |
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Telephone | 757-254-7197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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