MEDICARE: NIRVANA HAIR VA LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1891683181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIRVANA HAIR VA LLC

Provider Business Mailing Address
First Line	:	10019 JEFFERSON AVE
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23605-1044
Country	:	US
Telephone Number	:	757-254-7197
Fax Number	:	757-929-9095

Provider Business Practice Location Address
First Line	:	10019 JEFFERSON AVE
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23605-1044
Country	:	US
Telephone Number	:	757-254-7197
Fax Number	:	757-929-9095

Authorized Official
Title or Position	:	OWNER
Name	:	MS. MAREE NEWBY SANDERS
Credential	:
Telephone Number	:	757-254-7197

Provider Enumeration Date	:	06/25/2025
Last Update Date	:	05/06/2026

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Directions to “NIRVANA HAIR VA LLC ” Practice Location

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