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Organization

NIRVANA HOLISTIC HEALTH CENTERS, PLLC

Active
Other names
Nirvana Holistic Health Centers
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. KENDRA ALYSSA AVANT-ORTIZ FNP-C (CHIEF EXECUTIVE OFFICER)
(480) 241-3710
Entity
Organization

Contact information

Practice address
733 E UNIVERSITY DR, SUITE 4, MESA, AZ 85203-7965
(480) 890-3790
(480) 890-3051
Mailing address
733 E UNIVERSITY DR, SUITE 4, MESA, AZ 85203-7965
(480) 890-3790
(480) 890-3051

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP4495
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
135547
AZ
Enumeration date
04/28/2016
Last updated
09/28/2016
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