Provider Demographics
NPI:1366101974
Name:QUEEN'S BODY SPA
Entity type:Organization
Organization Name:QUEEN'S BODY SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEVELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-298-1494
Mailing Address - Street 1:4214 W WENDOVER AVE # 1147
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-1909
Mailing Address - Country:US
Mailing Address - Phone:336-298-1494
Mailing Address - Fax:
Practice Address - Street 1:327 E MONTCASTLE DR UNIT G
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-5340
Practice Address - Country:US
Practice Address - Phone:336-404-3295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty
No302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Single Specialty