Healthcare Provider Details

I. General information

NPI: 1366101974
Provider Name (Legal Business Name): QUEEN'S BODY SPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 E MONTCASTLE DR UNIT G
GREENSBORO NC
27406-5340
US

IV. Provider business mailing address

4214 W WENDOVER AVE # 1147
GREENSBORO NC
27407-1909
US

V. Phone/Fax

Practice location:
  • Phone: 336-404-3295
  • Fax:
Mailing address:
  • Phone: 336-298-1494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: REGINA NEVELS
Title or Position: OWNER
Credential:
Phone: 336-298-1494