Provider Demographics
NPI:1992527683
Name:ANOVA MED SPA LLC
Entity type:Organization
Organization Name:ANOVA MED SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHEYLOH
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUEMEL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:307-461-0845
Mailing Address - Street 1:1125 LEOPARD ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-4627
Mailing Address - Country:US
Mailing Address - Phone:307-752-1849
Mailing Address - Fax:
Practice Address - Street 1:1415 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2629
Practice Address - Country:US
Practice Address - Phone:307-752-1849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-24
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care