MEDICARE: BODY BELLA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251J00000X	Nursing Care Agency	CNP00223	NM

General Provider Information

NPI Number	:	1245609783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BODY BELLA

Provider Business Mailing Address
First Line	:	5020 CREOSOTE RUN RD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-2541
Country	:	US
Telephone Number	:	575-644-3786
Fax Number	:

Provider Business Practice Location Address
First Line	:	5020 CREOSOTE RUN RD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-2541
Country	:	US
Telephone Number	:	575-644-3786
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SUZANNE QUILLEN
Credential	:	CNP
Telephone Number	:	575-644-3786

Provider Enumeration Date	:	09/15/2015
Last Update Date	:	09/15/2015

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Directions to “BODY BELLA ” Practice Location

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