Healthcare Provider Details

I. General information

NPI: 1811827306
Provider Name (Legal Business Name): ELLIE'S AESTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3462 WHITE HOUSE DR SE
RIO RANCHO NM
87124-3678
US

IV. Provider business mailing address

3462 WHITE HOUSE DR SE
RIO RANCHO NM
87124-3678
US

V. Phone/Fax

Practice location:
  • Phone: 505-977-6375
  • Fax:
Mailing address:
  • Phone: 505-977-6375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ELLIE HARVEY
Title or Position: CNP
Credential: CNP
Phone: 505-977-6375