MEDICARE: NASHVILLE BLONDE LLC

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	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1962266809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NASHVILLE BLONDE LLC

Provider Business Mailing Address
First Line	:	2808 RICHMOND AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79930-3314
Country	:	US
Telephone Number	:	915-319-6941
Fax Number	:

Provider Business Practice Location Address
First Line	:	2808 RICHMOND AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79930-3314
Country	:	US
Telephone Number	:	915-319-6941
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROSA E MORALES
Credential	:
Telephone Number	:	915-319-6941

Provider Enumeration Date	:	02/12/2024
Last Update Date	:	02/19/2024

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Directions to “NASHVILLE BLONDE LLC ” Practice Location

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