Healthcare Provider Details

I. General information

NPI: 1962015958
Provider Name (Legal Business Name): EUN BELLISARIO CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6349 US HIGHWAY 550
CUBA NM
87013-6032
US

IV. Provider business mailing address

6349 US HIGHWAY 550
CUBA NM
87013-6032
US

V. Phone/Fax

Practice location:
  • Phone: 575-289-3291
  • Fax: 505-443-8303
Mailing address:
  • Phone: 575-289-3291
  • Fax: 505-443-8303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11008838
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number61906
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: