Provider Demographics
NPI:1689320111
Name:RAQUEL WALL NP, LLC
Entity Type:Organization
Organization Name:RAQUEL WALL NP, LLC
Other - Org Name:BEAUTY RESTORED AND WELLNESS LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN - NP
Authorized Official - Phone:435-359-3115
Mailing Address - Street 1:1490 E FOREMASTER DR STE 320
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4505
Mailing Address - Country:US
Mailing Address - Phone:435-359-3115
Mailing Address - Fax:435-291-1096
Practice Address - Street 1:1490 E FOREMASTER DR STE 320
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4505
Practice Address - Country:US
Practice Address - Phone:435-359-3115
Practice Address - Fax:435-274-0870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty