Provider Demographics
NPI:1992515209
Name:NUESTRA VIDA WELL LIVING, LLC.
Entity type:Organization
Organization Name:NUESTRA VIDA WELL LIVING, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TREVA
Authorized Official - Middle Name:V
Authorized Official - Last Name:RISHER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:541-227-1109
Mailing Address - Street 1:521 W 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97448-1620
Mailing Address - Country:US
Mailing Address - Phone:541-227-1109
Mailing Address - Fax:
Practice Address - Street 1:521 W 7TH AVE
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:OR
Practice Address - Zip Code:97448-1620
Practice Address - Country:US
Practice Address - Phone:541-227-1109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service