Healthcare Provider Details

I. General information

NPI: 1669266763
Provider Name (Legal Business Name): VICTORIA NESSLE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2025
Last Update Date: 04/05/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4147 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-6741
US

IV. Provider business mailing address

4147 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-6741
US

V. Phone/Fax

Practice location:
  • Phone: 505-553-0555
  • Fax:
Mailing address:
  • Phone: 505-659-2417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT20250038
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: