MEDICARE: IBASI HEALING MINISTRIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1437519584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IBASI HEALING MINISTRIES

Provider Business Mailing Address
First Line	:	606 SOUTH 9TH STREET
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101
Country	:	US
Telephone Number	:	209-329-1471
Fax Number	:

Provider Business Practice Location Address
First Line	:	606 S 9TH ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-7013
Country	:	US
Telephone Number	:	209-329-1471
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER, DIRECTOR
Name	:	DR. DEVI NOSTRUM
Credential	:	PHARM.D.
Telephone Number	:	209-329-1471

Provider Enumeration Date	:	03/02/2016
Last Update Date	:	03/02/2016

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