Healthcare Provider Details

I. General information

NPI: 1457565376
Provider Name (Legal Business Name): LIA BELLO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 81 BOX 6023
QUESTA NM
87556-9715
US

IV. Provider business mailing address

HC 81 BOX 6023
QUESTA NM
87556-9715
US

V. Phone/Fax

Practice location:
  • Phone: 505-586-1166
  • Fax:
Mailing address:
  • Phone: 505-586-1166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR44137
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024073425
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: