NPIMap

Organization Active NPI

Nirvana LLC

  • Dental Hygienist
  • Corrales, NM
National Provider Identifier
1710137773
Registry record updated Sep 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental HygienistTaxonomy code 124Q00000X
License
DH986 Issued in NM
Legal business name
NIRVANA LLC
Practice address
161 Railcar Rd
Corrales, NM 87048-7909
Phone
(505) 553-6850
NPI assigned
Sep 26, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Julie Raye Fuller, RDHNPI 1477703429
Title
Co-Owner
Phone
(505) 553-6850

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental HygienistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 124Q00000X DH986 NM Primary
Dental HygienistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 124Q00000X DH1235 NM

Addresses

Primary practice location

161 Railcar Rd
Corrales, NM 87048-7909

Mailing address

161 Railcar Rd
Corrales, NM 87048-7909
Phone (505) 553-6850

Other identifiers 1

IdentifierTypeStateIssuer
65028066MedicaidNM

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222387200000",
    "number": "1710137773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 RAILCAR RD",
            "city": "CORRALES",
            "state": "NM",
            "postal_code": "870487909",
            "telephone_number": "505-553-6850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 RAILCAR RD",
            "city": "CORRALES",
            "state": "NM",
            "postal_code": "870487909",
            "telephone_number": "505-553-6850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NIRVANA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-26",
        "last_updated": "2008-09-26",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "RAYE",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "505-553-6850",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RDH"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dental Hygienist",
            "state": "NM",
            "license": "DH986",
            "primary": true
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dental Hygienist",
            "state": "NM",
            "license": "DH1235",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65028066",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Corrales, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.