MEDICARE: NIRVANA HEALTH

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1568077519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIRVANA HEALTH

Provider Business Mailing Address
First Line	:	6732 DIVERS LOONS ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-2691
Country	:	US
Telephone Number	:	702-379-7571
Fax Number	:

Provider Business Practice Location Address
First Line	:	6732 DIVERS LOONS ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-2691
Country	:	US
Telephone Number	:	702-379-7571
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JENNASEN NARCISO
Credential	:
Telephone Number	:	702-379-7571

Provider Enumeration Date	:	09/15/2020
Last Update Date	:	09/15/2020

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Directions to “NIRVANA HEALTH ” Practice Location

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