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General NPI Number Information
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NPI Number | 1245609783
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Entity Type | Organization
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Legal Business Name | BODY BELLA
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 5020 CREOSOTE RUN RD
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City | LAS CRUCES
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State | NM
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Zip | 88011-2541
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Country | US
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Telephone | 575-644-3786
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Fax |
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Provider Business Mailing Address
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Address Line | 5020 CREOSOTE RUN RD
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City | LAS CRUCES
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State | NM
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Zip | 88011-2541
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Country | US
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Telephone | 575-644-3786
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUZANNE QUILLEN
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Credential | CNP
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Telephone | 575-644-3786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | CNP00223
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License Number State | NM
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