Provider Demographics
NPI:1700590965
Name:LIV BEAUTIFUL LLC
Entity Type:Organization
Organization Name:LIV BEAUTIFUL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:NORVELL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:702-201-1400
Mailing Address - Street 1:3200 SOARING GULLS DR STE 103
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-2198
Mailing Address - Country:US
Mailing Address - Phone:702-201-1400
Mailing Address - Fax:702-915-7514
Practice Address - Street 1:3200 SOARING GULLS DR STE 103
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-2198
Practice Address - Country:US
Practice Address - Phone:702-201-1400
Practice Address - Fax:702-915-7514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty