Provider Demographics
NPI:1891683181
Name:NIRVANA HAIR VA LLC
Entity type:Organization
Organization Name:NIRVANA HAIR VA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MAREE
Authorized Official - Middle Name:ANTONETTE
Authorized Official - Last Name:NEWBY SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-254-7197
Mailing Address - Street 1:33 WATERS EDGE CIR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-1920
Mailing Address - Country:US
Mailing Address - Phone:757-254-7197
Mailing Address - Fax:757-929-9095
Practice Address - Street 1:10019 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23605-1044
Practice Address - Country:US
Practice Address - Phone:757-254-7197
Practice Address - Fax:757-929-9095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies