Anu Glo Med Spa, LLC.
Nurse Practitioner, Adult Health in Snellville, GA. Organization (NPI-2).
NPI number1508470212
StatusActive
Last updated in NPPESSep 1, 2020
Details
- NPI
- 1508470212
- Entity type
- Organization (NPI-2)
- Legal business name
- Anu Glo Med Spa, LLC.
- Organization subpart
- No
- Enumeration date
- Sep 1, 2020
- Certification date
- Sep 1, 2020
- Last updated
- Sep 1, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LA2200X | Nurse Practitioner, Adult Health | – | – | Yes |
| 363L00000X | Nurse Practitioner | – | – | |
| 363LA2100X | Nurse Practitioner, Acute Care | – | – | |
| 363LP2300X | Nurse Practitioner, Primary Care | – | – |
Practice location
2429 Main St E Ste 6Snellville, GA 30078-3336
Phone 404-664-2505
Mailing address
1573 Stonegate WaySnellville, GA 30078-6701
Phone 404-664-2505
Authorized official
Ivy Cleveland
Owner
4046642505
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