Healthcare Provider Details

I. General information

NPI: 1568339588
Provider Name (Legal Business Name): ROSE & GLOW AESTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/23/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 HOLLY AVE NE STE 21
ALBUQUERQUE NM
87113-2629
US

IV. Provider business mailing address

7501 HOLLY AVE NE STE 21
ALBUQUERQUE NM
87113-2629
US

V. Phone/Fax

Practice location:
  • Phone: 505-584-5537
  • Fax:
Mailing address:
  • Phone: 505-584-5537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CELIA YAZZIE
Title or Position: NURSE PRACTITIONER/OWNER
Credential: CNP
Phone: 505-879-0946