Provider Demographics
NPI:1457565376
Name:BELLO, LIA (FNP)
Entity Type:Individual
Prefix:
First Name:LIA
Middle Name:
Last Name:BELLO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 81 BOX 6023
Mailing Address - Street 2:
Mailing Address - City:QUESTA
Mailing Address - State:NM
Mailing Address - Zip Code:87556-9715
Mailing Address - Country:US
Mailing Address - Phone:505-586-1166
Mailing Address - Fax:
Practice Address - Street 1:HC 81 BOX 6023
Practice Address - Street 2:
Practice Address - City:QUESTA
Practice Address - State:NM
Practice Address - Zip Code:87556-9715
Practice Address - Country:US
Practice Address - Phone:505-586-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR44137363LF0000X
VA0024073425363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily