Healthcare Provider Details

I. General information

NPI: 1669397055
Provider Name (Legal Business Name): ELLIE'S AESTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1634 ALAMEDA BLVD NW
ALBUQUERQUE NM
87114-8807
US

IV. Provider business mailing address

1634 ALAMEDA BLVD NW
ALBUQUERQUE NM
87114-8807
US

V. Phone/Fax

Practice location:
  • Phone: 505-279-1680
  • Fax: 505-214-7066
Mailing address:
  • Phone: 505-279-1680
  • Fax: 505-214-7066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELLIE HARVEY
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: NURSE PRACTITIONER
Phone: 505-977-6375