Provider Demographics
NPI:1295402832
Name:SANCHEZ-TLACOMULCO, NIRVANA
Entity Type:Individual
Prefix:
First Name:NIRVANA
Middle Name:
Last Name:SANCHEZ-TLACOMULCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 14TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4500
Mailing Address - Country:US
Mailing Address - Phone:320-774-3436
Mailing Address - Fax:
Practice Address - Street 1:205 14TH AVE E
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4500
Practice Address - Country:US
Practice Address - Phone:320-774-3436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician