Healthcare Provider Details

I. General information

NPI: 1669861506
Provider Name (Legal Business Name): SVELTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 LUISA ST STE 3B
SANTA FE NM
87505-4177
US

IV. Provider business mailing address

1300 LUISA ST STE 3B
SANTA FE NM
87505-4177
US

V. Phone/Fax

Practice location:
  • Phone: 505-400-3889
  • Fax:
Mailing address:
  • Phone: 505-400-3889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. TRACY NYMEYER
Title or Position: PRESIDENT
Credential:
Phone: 505-400-3889