Provider Demographics
NPI:1760085393
Name:NURSING MAMA LLC
Entity Type:Organization
Organization Name:NURSING MAMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MICHELETTI
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN, CLC
Authorized Official - Phone:469-992-5871
Mailing Address - Street 1:318 CREDIBLE LOOP
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-8864
Mailing Address - Country:US
Mailing Address - Phone:469-992-5871
Mailing Address - Fax:
Practice Address - Street 1:318 CREDIBLE LOOP
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-8864
Practice Address - Country:US
Practice Address - Phone:469-992-5871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care