Provider Demographics
NPI:1952757098
Name:NIRVANA HOLISTIC
Entity Type:Organization
Organization Name:NIRVANA HOLISTIC
Other - Org Name:NIRVANA HOLISTIC MEDICINE AND SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUNDEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:KNIGHTS
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:202-288-7666
Mailing Address - Street 1:5239 WESTERN AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2126
Mailing Address - Country:US
Mailing Address - Phone:202-288-7666
Mailing Address - Fax:
Practice Address - Street 1:5239 WESTERN AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2126
Practice Address - Country:US
Practice Address - Phone:202-288-7666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-08
Last Update Date:2016-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNP0040175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty