Provider Demographics
NPI:1205238896
Name:SVELTE LLC
Entity type:Organization
Organization Name:SVELTE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:V
Authorized Official - Last Name:NYMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-400-3889
Mailing Address - Street 1:2211 E HIGHLAND AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4834
Mailing Address - Country:US
Mailing Address - Phone:602-374-7226
Mailing Address - Fax:602-467-3130
Practice Address - Street 1:2211 E HIGHLAND AVE STE 215
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4834
Practice Address - Country:US
Practice Address - Phone:602-374-7226
Practice Address - Fax:602-467-3130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty