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Organization

BELLALUNA LIL LIGHT LLC/DBA MOUNTAIN GRIT WELLNESS LLC

Active
Parent organization
BELLALUNA LIL LIGHT LLC/ DBA MOUNTAIN GRIT WELLNESS LLC
Other names
Mountain Grit Wellness
Organization subpart
Yes

Provider details

NPI number
Legal business name
BELLALUNA LIL LIGHT LLC/ DBA MOUNTAIN GRIT WELLNESS LLC
Authorized official
SHARLENE E. ROGERS CNP (OWNER/MANAGER/PROVIDER)
(575) 491-2310
Entity
Organization

Contact information

Practice address
3496 US HIGHWAY 82, MAYHILL, NM 88339
(575) 687-4232
Mailing address
PO BOX 22, MAYHILL, NM 88339-0022
(575) 491-2310

Taxonomy

Speciality
Code
Description
License number
State
163WI0500X
Infusion Therapy Registered Nurse
261Q00000X
Clinic/Center
Primary
363LA2200X
Adult Health Nurse Practitioner

Other

Enumeration date
01/09/2025
Last updated
01/09/2025
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