Healthcare Provider Details

I. General information

NPI: 1760085393
Provider Name (Legal Business Name): NURSING MAMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 CREDIBLE LOOP
CLOVIS NM
88101-8864
US

IV. Provider business mailing address

318 CREDIBLE LOOP
CLOVIS NM
88101-8864
US

V. Phone/Fax

Practice location:
  • Phone: 469-992-5871
  • Fax:
Mailing address:
  • Phone: 469-992-5871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELISSA ANNE MICHELETTI
Title or Position: OWNER
Credential: BSN, RN, CLC
Phone: 469-992-5871