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General NPI Number Information
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NPI Number | 1952757098
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Entity Type | Organization
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Legal Business Name | NIRVANA HOLISTIC
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Dates
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Enumeration Date | 05/08/2016
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Last Update Date | 05/08/2016
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Provider Practice Location Address
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Address Line | 5239 WESTERN AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20015-2126
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Country | US
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Telephone | 202-288-7666
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Fax |
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Provider Business Mailing Address
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Address Line | 5239 WESTERN AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20015-2126
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Country | US
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Telephone | 202-288-7666
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHAUNDEL O KNIGHTS
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Credential | N.D.
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Telephone | 202-288-7666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | NP0040
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License Number State | DC
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